Cofton Medical Centre

Providing NHS Services

Ethnicity Questionnaire

The pandemic, amongst other things, has highlighted to us that COVID-19 (and some other diseases/conditions) can disproportionately affect different ethnicities.

It is important that we hold your ethnicity status so that we can ensure you are receiving the best quality healthcare (e.g. being including the correct at risk groups where necessary).

Please update us with your ethnicity status using the form below. If you would prefer not to disclose this information please choose this option on the form below and your choice will be recorded on your medical record.

Ethnicity Questionnaire
Please use format day/month/year e.g. 12/05/1979
What is your ethnic group?

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.