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GDPR

Under the new GDPR (General Data Protection Regulation) rules that came into force on the 25th May 2018 we now require you to actively give us permission to pass information about your care onto third parties or other people you may wish to be involved with your care. Please complete the form below and return it at your next consultation.

We hold your information carefully and safely in order that your privacy is protected. Please see the notice on our website under information documents for further details.

Your Consultant
Your Details
Your Address
Your Contact Details
Tick to give your permission
for Urology Partners LLP to contact you using the following methods
Who Can We Talk To?

If there are members of family or friends who need to discuss your clinical treatment with us, please confirm who we can speak to in the boxes below

Please tick one box below (For insured patients only)
I give my permission for Urology Partners to pass relevant information to my medical insurance company. This may be either verbal or in written form and may include details of my treatment, copies of clinic letters and test results.
Please tick one box below (For all patients)
I give my permission for Urology Partners to pass relevant information to any third party involved in my treatment. This may include my GP, clinicians and other relevant medical professionals. This may be either verbal or in written form.

Urology Partners will not discuss any aspect of your treatment (including times of appointments or treatments) with anybody other than yourself and those listed above, unless you have specifically authorised us to do so. Many patients find it helpful for us to be able to talk to members of the family or other individuals. If you are happy for us to talk to somebody other than yourself please list them below.