Concent Form for Recording



Page {{ paginatorProps.current }} of {{ }} ({{ paginatorProps.percentage }}% completed)

We are hoping to make video/digital recordings of some of the consultations between patients the Doctor whom you are seeing.

The recordings are used by doctors training to be a GP for training, educational or assessment purposes.

The recording is only of you and the doctor talking together. Intimate examinations will not be recorded, and the camera/recorder will be switched off on request.

All recordings are carried out according to guidelines issued by the General Medical Council and will be stored securely in line with the General Data Protection Regulation (GDPR). They will be deleted by 26 weeks (182 days) of the recording taking place.

You do not have to agree to your consultation with the doctor being recorded.

If you want the camera/recorder turned off, please inform reception or your doctor - this is not a problem and will not affect your consultation in any way. If you do not mind your consultation being recorded, please sign below. You will also retain the option to withhold or withdraw consent at the end of the consultation, and as such will also be asked to provide a further signature to confirm consent after the consultation.

Thank you very much for your help.

To be completed by the patient

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.