Record your ethnicity

Use this service to record your ethnicity in your health record.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of
• your ethnicity

Start now

You can also phone us on Branch 1 01234 567 890 or Branch 2 01234 567 891.