Request for medical records

Last Updated: 04/02/2025

Personal Details

Please complete all sections below.

Full Name *

Date Of Birth *

Phone Number *

Email Address

Current Address *

Medical record request

Please state the extent of your information request.

Please note all requests can take between 14-30 working days.

Once completed you will recieve a text to inform you for records are ready to collect.

Please note that if you have already obatianed a Full Summary from the surgery previously, you may be charged £50 for the next Full Summary you request.

WHEN COLLECTING RECORDS YOU WILL BE REQUIRED TO BRING PHOTO ID.

I understand that this form collects my name, date of birth and any other personal information that I choose to provide. This is to confirm I am registered with the practice; to allow the practice team to contact me and to update the medical records held by them and their partners in the NHS. I understand that I am able to read the privacy policy (Located at the footer of the website) to discover how they protect and manage my submitted data. *

I consent to the practice collecting and storing my data from this form and understand that anything not relating to this form will not be actioned

A Brief Medical Summary *

Yes No

A Full Medical Summary *

Yes No

A specific document

A copy of everything relating to?

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Request for medical records

Please note all requests can take between 14-30 working days.

Once completed you will recieve a text to inform you for records are ready to collect.

Please note that if you have already obatianed a Full Summary from the surgery previously, you may be charged £50 for the next Full Summary you request.

WHEN COLLECTING RECORDS YOU WILL BE REQUIRED TO BRING PHOTO ID.

Further Information

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