Organisations that provide healthcare for the NHS are required to collect information about the patients who use its services. The information on this form is collected to fulfil that obligation and to improve the services we provide. It is used for monitoring purposes only and ensures we treat all patients from across the community equally.
We will treat all personal information in line with current data protection legislation.
This form is entirely confidential. It is not traceable and does not affect the treatment you receive. Completion of the form is voluntary but please return it even if it is not complete.