Subject Access Request

This form is for the sole purpose of patients requesting access to or a copy of their health records under the General Data Protection Regulations 2016 Subject Access Request.

If you are requesting your blood tests results please be advised you will be contacted by a clinician if you are required to be seen for a follow up appointment. If you would like to view the results you can access through your online account.

Medical records will be sent to you in electronic form via email within 1 month from the date of your request. Please ensure you have provided the email address that is verified within your medical records for this purpose.

Subject Access Request Form

Details of Patient / Clients Records To Be Accessed

Details of Applicant

Are the applicant details different to the patients/ clients details? *

Please confirm the following: *

What is being applied for?

Please specify what it is you are applying for: *

You do not have to give a reason for applying for access to your health records. However, to help the Practice save time and resources, it would be helpful if you could provide details below, informing us of dates of your health records you require. Please use the fields below to document this information.

Dates and types of records or time frame

Please note that if you require your test results you should complete the SystmOnline form which will allow you to access your results within a shorter period of time.

Do you wish to access the whole electronic record? *
Do you wish to access any other information?

Attachments

Please upload any relevant documents to support your request. If you are unable to do so, you will need to provide this to the practice in person.
Maximum upload size: 67.11MB