Demographics Monitoring Form

Completing this form helps us to identify any existing inequalities and where new inequalities may be developing and take action to tackle them. While it is voluntary to tell us about this information, doing so will help us to better understand and address any disparities. Your answers will be treated in confidence, and all data disclosed will comply with the General Data Protection Regulations and any related data protection requirements. In completing this, you are giving us permission to collect and store the data anonymously to help us with our improvement plans. That means we will not hold this data on your records but use it to help us find out more about the wider make up of our communities.

This service is for non-emergency queries only.
  • call 999 for emergency medical help.
  • In England call 111 for urgent medical advice.
  • In Scotland go to NHS24.scot for urgent medical advice.
  • In Isle of Man call MEDS direct on +44 1624 650355 for urgent medical advice.

Before you start

  • Your practice will aim to respond to your query within 2 working days.
  • If you do not submit your query, no details will be sent to your practice.
  • You must be over 16 to use this service, although you may use this service to contact the practice about a person you care for who is under 16.
  • You must be currently registered as a patient with Five Oaks Family Practice .
  • You must be currently in the UK.