Decline online access to records

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Decline online access to records

If you want to decline online access to records, please complete this form

More information can be found on our website at ivy.gs/records

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Please confirm the following statements *

The patient wishing to decline online access to records is registered at Ivy Grove Surgery

By using this form you agree that an electronic signature is as effective as in paper format

By submitting this form, you agree to our privacy policy as at http://ivy.gs/privacy

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