Ethnicity Form



  • All our patients are being asked to describe their ethnic group. Although, you do not have to share your ethnic group, we hope that you will as providing the NHS with this information is very important.
  • It will help us with diagnosis and assessment of your needs. It will also help us to plan and improve our service.
  • The information you provide will be treated as part of your confidential NHS records.


Why are you collecting this data?

The main reasons we are asking to collect this data are set out below:

  • To understand the needs of patients from different groups. This allows us to provide better and more appropriate services to them.
  • To identify risk factors. Some groups are more at risk of specific diseases and some groups have specific care needs. Consequently, ethnicity data can help treat patients by alerting us to high-risk groups.
  • To improve public health. In sharing your ethnicity we can make sure that our services are reaching all our local communities and that we are delivering our services fairly to who needs them.
  • To Comply with the law. The Race Relations (Amendment) ACT 2000 gives public authorities, like us, a duty to promote race equality and good race relations and ethnic monitoring by making sure that race discrimination does not take place.

How often will you ask me for this information?

Once you have told us your ethnic group we will record it on your medical records. We do not need to ask you for it again.

Will you share this information?

The information you provide will be treated as part of your confidential notes. The NHS has strict standards regarding data protection and your information will be carefully safeguarded. If you would like to read more about your data please read our privacy notice.

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Ethnicity Questions

This list is designed to allow most people to identify themselves. However, if you feel that categories do not describe your ethnic group origin, please let us know and we will enter ‘any other group’; together with details of how you would describe yourself

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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