Record your ethnicity

Use this service to record your ethnicity in your health record.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of
• your ethnicity

Start now

You can also phone us on Broad Lane 02476 466 583 or City of Coventry 03333 324 555 or Stoke Aldermoor 024 7623 3940 or Foleshill 02476 707 030.