Patient Access to Medical Records Request

If you would to apply for access to your health records under the General Data Protection Legislation (Subject Access Request), please submit this form.

Please be aware, photo ID will be required when you collect the records.

Patient Access to Medical Records Request

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You do not have to give a reason for applying for access to your health records. However, please could you provide details regarding details of the information you require to access. Such information would be time periods and elements of your health records, along with details which you may feel have relevance i.e. consultant name, location, written diagnosis and reports etc.

Please select the appropriate option identifying whether you or a representative on your behalf is applying for access: *

Please enter the patient's details at the beginning of this form, and your details below:

I understand that medical records contain sensitive and personal information and I agree that I am fully responsible for the records once they leave The Limes Medical Centre.