Medical Information / Subject Access Request

Medical Information / Subject Access Request

This form is for the intention of requesting medical information only. 

Upon receipt of your request, the practice will aim to respond within 30 working days.

Please consider downloading the NHS App

  • SECTION 1 - YOUR DETAILS

    Date of Birth
    For example, 15 3 1984

  • SECTION 2 - MEDICAL REPORT REQUEST

    Please note that not all services are covered under the NHS contract. Some requests such as certain medical reports, letters, or forms, may fall outside of NHS-funded work and will incur a Fee. You will be informed in advance if charges apply.

    What type of medical report do you require?

  • SECTION 3 - MEDICAL RECORDS (Subject Access Request)

    WHAT TYPE OF MEDICAL INFORMATION DO YOU REQUIRE?

  • APPLYING ON BEHALF OF SOMEONE

    If you are requesting information on someone else’s behalf, we will require proof of authority. Without this we will be unable to process the request.  

    The practice will contact you for proof of authority once your request has been received.

    PLEASE SELECT FROM THE FOLLOWING:
    THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA
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Page last reviewed: 10 September 2025
Page created: 10 September 2025