Summary Care Record

Your Summary Care Record is a short summary of your GP medical records. It tells other health and care staff who care for you about the medicines you take and your allergies.

This means they can give you better care if you need health care away from your usual doctor’s surgery, for instance in A&E or when you are on holiday.
If you agree, we will include additional information in your Summary Care Record. This will help you get better care when you are away from the GP practice.

Find out more about the Summary Care Record Scheme

If you wish to opt out of the Summary Care Record scheme, please complete this form.

Please note: If you do not allow us to include additional information in your Summary Care Record, your care may be harmed if you get seriously ill.

Please fill in your details here to opt out of the Summary Care Record Scheme. We recommend that you read this detailed information about Summary Care Records before submitting your request.

Yes - I would like a Summary Care Record

Yes

Express consent for medication allergies and adverse reactions only

Express consent for medication allergies adverse reactions and additional information

No - I would NOT like a Summary Care Record (I would like to opt out)

Express dissent for Summary Care Record (Opt out)

Name of Patient*

Address*

Postcode*

Email in case we need to contact you*

Phone number (for contact)

Date of Birth (DD/MM/YYYY)*

NHS Number (if known)

Are you filling out this form on behalf of another person?*

Yes

If so, what is your name?

And what is your legal status in relation to the patient?

Parent

Legal Guardian

Lasting power of attorney for health and welfare

Opening hours

Important - Flu vaccinations 2026/27

Summary Care Record