Peverell Park Surgery & University Medical Centre

Peverell Park Surgery | 01752 766644

University Medical Centre | 01752 222341

Online Consultation is available between 8:00am-3:00pm weekdays (excluding Bank Holidays). Click on the Appointments menu below and select Online Consultation.

Ethnicity Questionnaire

 

GP practices are contractually obliged to record patients’ ethnicity in their health records where patients are happy to share it.

Improved Health Outcomes

By collecting and processing ethnicity information, Peverell Park Surgery can identify any potential health inequalities or disparities that may exist between different ethnic groups. This can help us tailor are healthcare services to your specific needs and ensure you receive the best possible care.

 

Please complete this short questionnaire if you have been invited by the practice and are happy to do so.

Ethnicity Questionnaire Form

Name(Required)
DD dash MM dash YYYY
Ethnicity(Required)

What happens to my information?

Personal and medical information about patients registered at Peverell Park Surgery is primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you. We sometimes use accredited suppliers for our communication with you (please refer to our Privacy Policy), for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols. To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.
Consent(Required)
This field is for validation purposes and should be left unchanged.

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