Access to Health Records/Subject Access Request 

Access to Health Records/Subject Access Request

The UK General Data Protection Regulation 2016 (UK GDPR) and Data Protection Act 2018 gives every living person, or an authorised representative, the right to apply for access to health records. Please contact us for alternative methods of obtaining access if you are unable to make a request in writing.

I am

Patient's Details

Name:
Please included any former names
DD slash MM slash YYYY
Please double check you’ve entered the correct email address
Current Address:
Would there have been a former postal address we would have on record?:

Additional Information

DD slash MM slash YYYY
DD slash MM slash YYYY
e.g. radiology results, information relating to a specific accident
I declare that 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(s) referred to above, under the terms of the Access to Health Records Act (1990) / Data Protection Act: