Summary Care Record (SCR) Opt Out

If you do not want a Summary Care Record or a Hampshire Healthcare Record, please fill in this form.

If you are filling this form on behalf of another person or child, please ensure you fill their details in section A and your details in section B.

Section A
Section B
Data for Research
Summary Care Record
Hampshire Healthcare Record
Adult Health (not children) Check Programme

Please be aware that the surgery is unable to opt patients out of all screening services. Patients are required to do this directly with the screening services themselves.

or Cancel