Patient consent form for sharing medical information

Use this service to give consent for sharing medical information.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

If you would like to print a copy off and fill in, please click on the below link, or continue to the start now button to complete online.

• complete the consent form (PDF)

Start now

You can also phone us on Cardinal Medical Practice (Deben Road) 01473 741 349 or Norwich Road (Branch site) or Chesterfield Drive (Branch site) .