First Contact Physiotherapist

Please do not use this form, you must complete a temporary registration form.

Dear Patient,

In order to improve the information available to the out of ours service (GMEDS), Ambulance Service and Secondary Care (Hospital) it is now possible for some of the information held in GP records to be made available electronically to them by Key Information Summary (KIS). In order for this to happen, we need your permission to allow us to switch the transfer on. The information can only be accessed by those clinicians who require it. The information includes up to date medication lists and major health issues. This information is very important in an emergency and could reduce delays in treatment. If you are happy for this information to be shared, please complete the relevant section below

For patient

I give my permission for my records to be shared for the use of KIS

For parent if applicable

I give my permission for the records of ............, for whom I am the parent, to be shared for the use of KIS

For guardian if applicable

I give my permission for the records of ..........., for whom I hold Welfare Power of Attorney/Guardianship, to be shared for the use of KIS