Children's Surgery Outcome Reporting (CSOR) programme opt-out form

Fields marked with an asterisk* are mandatory

Child's first name *

Child's middle name

Child's last name * Family name

Child's date of birth *

Day

Month

Year

Enter your child's date of birth as DD/MM/YYYY for example 01/02/2020.

Gender *

Child's postcode * You must enter the home postcode you registered with your GP surgery and include a space in the middle. For example EN1 1BE.

Child's NHS number You can find your NHS number at https://www.nhs.uk/nhs-services/online-services/find-nhs-number/

Why do you wish to opt out? We use this information to better understand patient attitudes to data sharing and improve our future communications.

This is an opt-out form

You should only submit this form if you do not wish your child to be invited to take part in the research programme.