Type 1 Opt-out Preferences

You can use this form to:

  • Register a Type 1 Opt-out, for yourself or for a dependent (if you are the parent or legal guardian of the patient) (to Opt-out)
  • withdraw an existing Type 1 Opt-out, for yourself or a dependent (if you are the parent or legal guardian of the patient) if you have changed your preference ( to Opt-in )

This decision will not affect individual care and you can change your choice at any time, using this form.

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Personal Details
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Preferences & Declaration

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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