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.

Last Updated: 09/04/2025

Your Details

Name *

Date of Birth *

Phone Number

Email Address *

Named GP (if known)

Report

What dates would you like your medical records from? *

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.

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.

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Subject Access Request

Further Information