Subject Access Request

If you need access to your medical records for any reason please complete this form.

Please be specific in your request so that we can prepare your records accurately. Under GDPR the Practice will contact you within 28 working days. Please do not contact the Practice by telephone to enquire if your records are available. This helps keep our telephone lines free.

Your Details

Name *

Previous Surname if applicable:

Date of Birth *

Phone Number

Email Address *

Named GP (if known)

Report

When you request access to your medical records these include:

any consultation you have had with a GP
any blood test/investigations that have been carried out by the Practice
any referrals that have been made by the Practice
any consultation you have had with Out-Of-Hours
clinical letters relating to your attendances at hospital

This can often be lengthly therefore if you require specifics, it is helpful for us to know when preparing your records.

If you require a summary of your record, and not FULL history please select:

If you require FULL medical records, what dates would you like these from? *

For what purpose do you need these notes? *Please note that you have no obligation to disclose this information to the Practice, however it is helpful for us when preparing your records.

THIS FORM COLLECTS YOUR PERSONAL INFORMATION. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE ADMINISTRATION TEAM TO CONTACT YOU. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

The Practice can send your medical records to you via email. If you would prefer this method of communication, please indicate below. We will contact you via email when your records are available, and will email them to the address specified. *

I consent to the Practice sending my records to me via email.

I do not consent to the Practice sending my records to me via email. I wish to collect my records from the Practice.

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Page last reviewed: 25 November 2025
Page created: 07 July 2023

Subject Access Request

Subject Access Request

Further Information