Consent to Share Confidential Information with a Third Party

The Data Protection Act 2018 and the ethical codes of conduct of all health care professionals require that medical data be treated with great respect for confidentiality. We are not permitted to share any medical details with a third party without your consent.

If you would like to consent to share confidential information with a third party, please use the form below:

Consent to Share Confidential Information with a Third Party

Consent to Share Confidential Information with a Third Party

Patient Details

I give consent to the sharing of my medical information with:

What type of information can be shared:

All information:
Test Results:
Appointment Information:
Medications:
Other Information:

Please tell us if this consent is permanent or for a short period of time:

Is this consent permanent?

If consent is not permanent, please provide a start date and end date for the consent:

Please note: It is your responsibility to inform us if you change your mind and wish to remove your consent to share your medical information with the above mentioned person.