Opt-out

Opt-Out Form

To request for your personal data to be removed and/or not included in the CADRE database, please complete this form. Should you prefer, you can also download a copy of the form here and email the completed version to Cadre@cpft.nhs.uk.

Please note that opting out of your data being shared for research purposes is your choice, and it will in no way affect the care you or your family receive.

1. Contact Details

a) Details of the patient

Full Name

First Last

Date of Birth

NHS number (if known)

Address

Street Address Address Line 2 City County / State / Region Postcode Country

Email address

Phone number

b) Details of parents or legal guardian

If you are filling in this form on behalf of a dependent e.g. a child, the CADRE team will first check that you have the authority to do so.

Full Name

First Last

Address

Street Address Address Line 2 City County / State / Region Postcode Country

Relationship to patient

2. Request

Please tick the relevant box below:

I request that my personal data is not included in the CADRE database and understand that this request will apply to future processing and data transfers where feasible.

Opt-out

3. Signature

By clicking “SUBMIT” below, I confirm that:

The information I have given in this form is correct

I am the individual named on this form (or am legally authorised to act on their behalf if applicable).

Signature (Please print your name here)

This field is for validation purposes and should be left unchanged.

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Opt-Out Form

1. Contact Details

2. Request

3. Signature

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We are a new database in development, supporting the physical and mental wellbeing of young people aged 0 to 24 in Cambridgeshire, Greater Manchester, Merseyside and West Midlands.

Children + Adolescents Data Resource