Historic Electronic Record Access Request Form

You are able to request your historic record be released electronically for personal review only.

Please do not use this form if you require access for any 3rd party source, such as benefits/solicitors. These requests should still be made via a SARS request to the practice.

Please bare in mind that as we are large practice, historic access requires a full record review and may take substantial time to process. These are not processed as urgent requests.

For this review to be undertaken and your record to be release to you we simply ask that you fill the form below, provide necessary ID, and the practice will review your record.

You will be contacted once your request has been processed. 

This form is for historic online record access only. Not to request a paper copy of your medical records.

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)
Personal Details
Please double check you've entered the correct email address
Confirm request
Documents required

Please provide 2 forms of ID:

  • Photographic ID that is in date such as a driving license or Passport
  • A recent letter addressed to you, dated in the last 3 months
If no ID is supplied, we cannot process the form
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
Previous Page  
Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.