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Consent to discuss medical information

Consent to Discuss Medical Information

Section

Person you are giving consent for

Who would you like to discuss your medical information with?

Relationship to you:

Consent details

What information are you happy for us to discuss?
How long would you like this consent to remain active?
Please use format DD/MM/YYYY

Important information

This form only gives permission for Horizon Healthcare to discuss your medical information with the named person.

It does not provide:

  • Online access to your GP record
  • NHS App access
  • Linked profile access
  • Proxy access to online GP services

Declaration

Confirmation
Enter full name
Upload identification documents (optional)
We may request identification documents to help protect patient confidentiality
Maximum upload size: 67.11MB