Withdrawing consent - British and Irish Orthoptic Society

If you have had your orthoptic assessment recorded in the past, and would like to have your recording permanently deleted, please complete the following form.

You do not have to give a reason for withdrawing your consent.

Please note, we require the patient's contact details (phone or email) so that we can confirm with them that the recording has been permanently removed.

I am a..(Required)

If you are not the patient, please enter your name:

If you know the unique Video ID number associated with this patient, please enter it below:

Patients name:(Required)

Patient's phone number:(Required)

Patient's email address:(Required)