Cookie	Purpose	Expiry
cookie-popup	Keeps track of whether you choose to 'Use necessary cookies' or 'Allow all cookies'	1 year

Cookie	Purpose	Expiry
accessibility-controls	Records option regarding additional cookies.	End of browsing session
saveFontSize	Allows the website (CMS) to record if the user’s font size selection.	End of browsing session
contrast-mode	Allows the website (CMS) to record the user’s contrast mode selection.	End of browsing session
googtrans	Allows the language of page content to be changed and records the language selected.	End of browsing session

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Cookie	Source	Purpose	Expiry
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Application to amend or remove information

This form allows you to have factual errors in clinical records corrected. However, a clinical opinion cannot be changed and if you disagree with some opinions, you can request your own version to be included in your records.

Section one: application details

Full name Required

Address Required

Post code Required

Telephone number Required

Email address Required

If the application is being made on behalf of the patient, please state relationship to patient, provide written consent or copies of legal documentation that provide you with authority to act on their behalf.

Relationship to patient Required

Patient full name (if different to above)

Patient address (if different from above)

Patient post code (if different from above)

Patient telephone number (if different from above)

Section two: purpose of request

What is the purpose of your request? Required

Amendment

Removal

Please state the amendments that need to be made to record(s) and why they are necessary:

Please identify the specific records that you consider should be removed and the reason why that is necessary

Section three: certification

I certify that the information listed in sections 1 and 2 above is accurate and request that amendments be made to my record. Required

Ticking this box acts as your signature

Date of submission Required

I agree to the privacy policy

Application to amend or remove information

Section one: application details

Section two: purpose of request

Section three: certification

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