Fields marked with a red asterisk are compulsory.*
Under the terms of its NHS Contract the Surgery is requested to ask all new patients to describe their own ethnic group. We should be grateful if you would do so below and return this form to us. The list is designed to allow most people to identify themselves. However, if you feel the categories do not describe your ethnic group, please let us know and we will enter ‘any other group’ together with details of how you would describe yourself (e.g. ‘Cornish’).
The reasons given for collecting this data are that ‘information on ethnicity is important because of the need to take into account culture, religion and language in providing appropriate individual care, changing legislation, the importance of providing information on ethnicity for shared care including secondary care and the need to demonstrate non-discrimination and equal outcomes.’.
If you choose not to complete the question (or the form is not returned within four weeks) we will assume that you have exercised your right to refuse to divulge your ethnicity. However experience shows that when people are asked their ethnic group, the proportion of people who choose not to answer is small.
If you do not return this statement within one month of registration then we will assume that you do not wish your ethnicity to be recorded
The information you provide will be treated as part of your confidential medical record and will not be shared with any other person or organisation. The NHS has strict standards regarding data protection and your information will be carefully safeguarded.
If you have any concerns or questions regarding this request, or you want to make any comments or complaint about the collection of this information, please contact the Patient Advice and Liaison Service (PALS) on 01209 886595