Type 1 Opt-out Form

Register your Type 1 Opt-Out Preference

Your Details

Name
Date of Birth
Email

Your Decision

Please select one of the following:

Your Declaration

I confirm that:

  • The information I have given in this form is correct
  • I am the parent or legal guardian of the dependent person I am making a choice for set out above (if applicable)
Date

GP PRACTICE CODING INSTRUCTION

Opt Out – Dissent code: 9Nu0 (827241000000103 Dissent from secondary use of general practitioner patient identifiable data (finding). Opt In – Dissent withdrawal code: 9Nu1 (827261000000102 Dissent withdrawn for secondary use of general practitioner patient identifiable data (finding)
This field is for validation purposes and should be left unchanged.