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

If you are human, leave this field blank.

Section

Named GP (if known):

Please specify your request: *

Entire medical record

Information required between specific dates

Start date: *

Please use the format DD/MM/YYYY

End date: *

Please use the format DD/MM/YYYY

Relating to what medical condition(s): *

Do you require copies of correspondence/hospital letters we hold? *

Yes

Any further comments?

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: *

I am aware that the practice outsources requests for access to medical records to iGPR and I consent to this. iGPR manages the reporting process for the practice by reviewing and responding to requests in accordance with our instructions and all applicable laws, including UK data protection laws.

I am able to collect my paperwork from the practice if it cannot be received electronically.

I confirm that my request is not urgent and that I may be contacted by the practice or iGPR for further information or clarification about the request.

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