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

Patient Details

Please use this date format: DD/MM/YYYY
Any responses we send will go to this email address

Ethnicity

Please specify the ethnic group you consider you belong to: *