Patient Ethnicity

Given Name *

Surname *

NHS Number

Date of Birth *

Mobile Number

Home Number

I consent to receiving SMS text reminders and other health information from the Practice *

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Ethnicity

In line with Government advice and NHS guidance, it is important that health care providers can identify patient ethnicity in order to offer appropriate guidance and support for those of us who are more vulnerable to certain diseases. Please select the appropriate choice to indicate your ethnicity. This will be recorded on your health records. You may opt out if you wish to do so.

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