Consent to Share Health Information

If you would like to give consent to a family member or carer to discuss your health records. Please complete the below form and bring it into the practice. 

This forms needs to be completed by yourself and needs your signature witnessed by a third party. 

If you have a Lasting power of atternory (LPA) you can send us a copy of this via email to nelondonicb.leytonhealthcarepatients@nhs.net

 

Page last reviewed: 15 July 2026
Page created: 15 July 2026