Albion Medical Practice

Including ethnicity in your medical record

Studies show that our racial and ethnic backgrounds may place us at different risks for certain diseases. Including ethnicity in your medical record will help us provide a higher quality of care.

Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Telephone Number*
Email*
example@example.com
Please specify which ethnic group you belong to*
Should be Empty:

Albion Medical Practice

Including ethnicity in your medical record

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