At Preston Park Surgery we strongly encourage you to consider opting to have a Summary Care Record with Additional Information (SCRAI), as it contains so much more information and is therefore significantly more useful both to you and the NHS staff treating you.

Consent for Summary Care Record

If you are human, leave this field blank.

Please view our Summary Care Record Letter.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.

Phone Number:

Email Address: *

This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

*

I have read the above letter about Summary Care Records

Do you give consent for your Summary Care Record?

Yes

SCRAI - Express consent for medication, allergies, adverse reactions and additional information.

SCR - Express consent for medication, allergies, and adverse reactions only.

No

Express dissent for Summary Care Record (opt out)