Access to medical records

Access to Detailed Medical Records

To request access to detailed paper medical records, please complete this form. Once we receive your request, we will ask you to provide two forms of identification:

Photo ID (e.g., Driving Licence, Passport)
Proof of Address (e.g., Utility Bill, Bank Statement)

⚠️ Important: Please ensure you provide accurate contact details so we can send you the ID verification request.

FAILURE TO SUBMIT A MOBILE OR EMAIL ADDRESS WILL MEAN THAT YOU WILL NEED TO ATTEND THE SURGERY TO PROVIDE IDENTIFICATION DOCUMENTS

Last Updated: 04/03/2025

Patient Details

To verify your request - It is important that we have either an up-to-date mobile telephone number or email address.

Title *

Forename *

Surname *

Date of birth *

Address *

Postcode *

Telephone Number

NHS Number (If Known)

Record requested by patient

Please tick the relevant boxes. The more specific that you can be, the easier it is for us to quickly provide you with the records requested.

Record you are requesting *

I am applying for access to view my records only (From November 2023)

I am applying for a printed copy of my medical record

What information are you requesting? *

Further Information (Dates or condition if you selected answer (A) or (B) in previous answer)

Declaration & Consent

Declaration and Signature
By entering your name below, you confirm that the information provided in this form is complete, accurate, and truthful to the best of your knowledge. You acknowledge that providing false or misleading information may result in further action.

Signature (Full Name) *

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Access to medical records

Further Information

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