Tell us whether you accept cookies

We've put some small files called cookies on your device to make our site work. We would also like to use analytical cookies to understand how our site is used and improve user experience. Analytical cookies send information to Google Analytics.

Let us know your preference. We will use a cookie to save your choice. Before you make your choice you can read more about our cookie policy.

Eleanor Cross Healthcare NHS GP Surgery in Northampton

Ethnicity data

Ethnicity Data Form

About you

Surname: *

Forename: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Email Address: *

Ethnicity Data

Please select your ethnic background from the options below: *

White

Mixed

Asian

Black

Other

English / Welsh / Scottish / Northern Irish / British

Irish

Gypsy or Irish Traveller

Caribbean

African

Asian

Any other White background

Any Mixed / Multiple ethnic background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

African

Caribbean

Any other Black background

Arab

Any other ethnic group

If you have selected ‘other’, please describe your ethnicity:

If you are human, leave this field blank.

Delapre Medical Centre
Gloucester Avenue
Northampton
NN4 8QF

Get directions

01604 708481

Whitefields Surgery
Hunsbury Hill Road
Camp Hill
Northampton
NN4 9UW

Get directions

01604 760171

Fit notes (sick notes)

Test results

Feedback and complaints

Wellbeing

Accessibility statement

Website policies