Medical History Report (Subject Access Request)

If you would like to make a subject access request, please use this form.

Please state exactly what information you are requesting. If entire medical records are required, please state. We will process your request within 28 days of receipt of your request.

Please note: You will need to bring photo ID when collecting your report.

Subject Access Request


Please specify your request: *
Please use the format DD/MM/YYYY
Please use the format DD/MM/YYYY
Do you require copies of correspondence/hospital letters we hold? *

By submitting this form, you indicate that you are the individual named above or have legal responsibility. The practice cannot accept requests regarding your personal data from anyone else, including family members. If medical information has already been given in the past 2 years the practice does not need to reissue it. Repeat requests will be/may be chargeable.

Please confirm the following: *