Request a copy of your medical records

You can request a copy of your medical records. Just complete the form below, and one of our team will contact you to discuss your request.

First Name

Last Name

Date of Birth (dd/mm/yyyy)

Phone

Address

Please enter the timeframe of the medical records you’re asking for (e.g. January 2015–December 2020)

In order for us to verify your identity, we’ll follow up with an email asking you to provide a copy of one of the following. Please tick the document you intend to provide:

Passport

Drivers licence

Other photo ID

Proof of address

I consent to this message being sent electronically to the practice. I have checked that the email address and phone number supplied are correct and consent to receiving medical information via email or text.

By submitting this form you will be sending personal/sensitive information about yourself across the Internet. Please read our privacy statement to discover how we protect and manage your submitted data. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of contacting the practice.

Request a copy of your medical records

Contact

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Links

For Life Threatening Emergencies - Call 999 or 112