Summary care record opt out

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I have no objections to my email address being added to my medical record as a future form of correspondence. Please note, this will only be used for actions such as sending letters to you or reminding you of reviews and will not be used for any marketing purposes.

Which surgery is normally attended?

Mile End Surgery

Tuckswood Surgery

Gurney Surgery

Patient Address (including postcode):

Patient NHS number (if known):

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