Including ethnicity in your health record

Information about your race and ethnicity helps us make sure we provide the highest quality of care for all patients. Studies show that our racial and ethnic backgrounds may place us at different risks for certain diseases.

Please submit the form below so we can make sure your ethnicity is included in your medical record.

Ethnicity Data

Are you completing this form on behalf of: *
Please use date format: DD/MM/YYYY


Please specify the ethnic group you consider you belong to: