If you would like to opt out of the care data extract you will need to print and complete the form below and return it to the surgery for the attention of the practice manager. Anyone over 16 years of age must complete and sign their own form. The form allows you to include the details of two minors, if you need to submit the details of more than two minors you will need to complete several forms. The data extract opt out code will only be applied to your medical record if you have submitted a signed opt out form. If you have any questions about this please do not hesitate to contact the practice.