National Diabetes Consent

You only need to complete this if you have received a letter from us asking for your consent. Please be aware local programmes are unable to invite patients for screening who withdraw their consent to the transfer of patient information.

Please do not complete this form if you have not received a letter.

Patient Details

Name
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NHS Diabetic Eye Screening Programme

The surgery provides your information to the NHS Diabetic Eye Screening Programme because we have a duty to make sure you receive an invitation for eye screening as part of your diabetes care. The information the programme has about you is:
Your name
Date of Birth
Contact details
NHS number
Details of your GP
Information to help establish your preferred language and contact method
Whether you might need large print documents
Whether you have been diagnosed with Type 1 or Type 2 diabetes

Please choose your preferred option:
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National Diabetes Audit

People with diabetes should receive annual care checks each year and should be achieving a target for their blood glucose, cholesterol and blood pressure values. The main national diabetes audit collects information from general practices to look at whether people with diabetes are receiving their annual care checks, are achieving their treatment targets and looks at their health outcomes along with whether they have been offered and attended structured education.

Please choose your preferred option:
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