Opt out or back in to Research involvement

Opt out or back in to Research involvement

Form for patients to opt out of research contact and to opt back in should they so wish later

 

OPT OUT OF RESEARCH (or back in as required)

Participating in clinical research and disease surveillance helps to develop new treatments and medicines for the future.

 

However, we are aware that some of our patients would not wish to be contacted regarding research.

 

Please use this form if you wish to opt out.

Below this there is an option to opt back in again should you change your mind at a later date






Details of Parent or Legal Guardian

If you are filling in this form on behalf of a dependent e.g. a child, the GP practice will first check that you have the authority to do so. Please complete the details below:




YOUR DECISION

By selecting the option below you are confirming that the information given in this form is correct OR that you have authority to act on behalf of the third party named above

AND THAT YOU DO NOT WISH TO BE CONTACTED FOR REASEARCH PURPOSES


CHANGING YOUR DECISION

This is for those pateints who have opted out and wish to change their mind


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Page last reviewed: 15 July 2025