Consent to Request NHS Number

We would like your permission to obtain your NHS number from your GP. This information is needed as part of our legal obligation to provide private patient data to the Private Hospitals Information Network (PHIN).

If this is acceptable, please complete the form below.

Name *

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Date of Birth *

Consent *I consent for Kinvara Private Hospital to obtain my NHS number from my GP. I understand Kinvara Private Hospital requires this information as part of its data submission to the Private Hospitals Information Network (PHIN), and is a legal requirement. I understand my NHS number will be retained by Kinvara Private Hospital indefinitely for future reference.

GDPR Agreement *I understand that my data will be handled in compliance with all relevant privacy and confidentiality regulations.

Signature *

Today's Date *

8 July 2026