NHS Test and Trace - Leavers Form

We’re sorry to see you go. If you no longer wish to be a Clinical Contact Caseworker / Team Leader as part of the NHS Test and Trace service, please complete the form below so that we can deactivate your account.

First name:

Surname:

Phone number:

Please confirm you Email address (that you registered with):

Please confirm your Date Of Birth:

**Please enter date format as dd/mm/yyyy if not prompted**

Please select your reason for leaving:

Please provide further comments:

Confirmation and giving your consent: