Access to Records Application
Personal information collected from you by this form is required to enable your request to be processed, this personal information will only be used in connection with the processing of this request. We will supply medical records in paper format or alternatively you can gain access to your records online.
This form is for individuals requesting their own records or on behalf of the patient, not for third party organisations.
Charges Payable: In accordance with legislation no fee will be charged for your request, unless the request is manifestly unfounded or excessive, particularly if it is repetitive (e.g. multiple copies). Before any further action is taken, we will contact you with details of our “reasonable administrative charges” in order to comply with your request.
Please enter the details below of the PATIENT you wish to enable online record access for. If you are requesting PROXY access to another patient's account, you will be prompted to enter further information of the proxy user on the next page.