Please note that records will be provided on CD/DVD or via a secure email unless specifically requested otherwise.
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 record referred to above under the terms of the General Data Protection Regulation/Data Protection Act 2018 and Access to Health Records Act 1990 on the grounds that: (please tick the appropriate box)
I authorise the representative, named above to apply for access to my health record under the Data Protection Act 1998.
In order to process your request we require proof of identification. Please attach a copy of your passport, driver’s licence or other valid identification, as well as a proof of address. If you are applying for access on behalf of the patient you will need to provide proof of your identity as well as that of the patient, as well as any other required legal documents.
There is no fee for subject access requests. However, if the request is excessively large or for repeated requests there may be an administrative fee to pay. If this is the case, we will contact you to let you know.
Our privacy statement explains how we protect any sensitive information you provide us with, and how we use information gathered while providing your healthcare.
(Please do not share any personal details.)