Access to Records

Under the Data Protection Act 1998 you do not have to give a reason for applying for access to your health records.

If you would like to request access to your records, please complete and submit this form.

Access to Medical Records

Patient Details

Details of the person wishing to access the records if different from above

Patient Consent Given:

No information can be given without the patient's consent.

Details of information required

Please check all that apply

If you request full access the charge may be higher (up to £50 if this is your second request).

Declaration

I declare that the information given by me is correct to the best of my knowledge and that I am entitled to apply for access to the health records referred to above under the terms of the Data Protection Act 1998.

Tick whichever of the following statements apply *