Special Patient Note Service – Request User Removal

Please fill out the below form to remove access to the Adastra Special Patient Note Service (Web Access).

Please note, the request will be processed 5 working days after submission.

User Removal Request Form

    [md-form]

    [md-text label="Your forename"]

    [/md-text]

    [md-text label="Your surname"]

    [/md-text]

    [md-text label="Your job title/position"]

    [/md-text]

    [md-text label="GMC/NMC Number (if applicable)"]

    [/md-text]

    [md-text label="Your contact number"]

    [/md-text]

    [md-text label="Your email" help="Must be a @nhs.net email address"]

    [/md-text]

    [md-text label="Your practice name"]

    [/md-text]

    [md-text label="Your practice ODS code (P or Y number)"]

    [/md-text]

    [md-text label="Your practice manager's name"]

    [/md-text]

    [md-text label="Your practice manager's email address" help="Must be a @nhs.net email address"]

    [/md-text]

    [md-submit][/md-submit]

    [/md-form]