Opt Out of the Wirral Care Record

Name

Address

Date of Birth
 

Your NHS number (if known)

Your GP Practice

Why do you wish to opt out of the Wirral Care Record? Please tick any or all that apply to you



If you selected 'Other' in the previous answer, please let us know a bit more information.

Where did you hear about the Wirral Care Record? Please tick any or all that apply to you