Your surgery will be closed on Thursday 13th June from 12.30pm onwards for routine appointments. Your surgery is closed for routine appointments to enable your practice staff to attend an afternoon of education and training. If you need medical attention that afternoon and feel that your problem cannot wait until the following day or you cannot be helped by another community provider, for example your pharmacist, the local out of hours service Hantsdoc will be providing medical care. You will need to call 111 (as you would out of hours at evenings and weekends) and they will involve Hantsdoc if needed. Your surgery will be open for business as usual on Friday 14th June at 8.00am. 

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Patient Access to Medical Records – Request Form

Patient Details

 
 
 
 
 
 

What is being applied for (tick as applicable):

 
You do not have to give a reason for applying for access to the health records. However, to help the Practice save time and resources, it would be helpful if you could provide details below, informing us of periods and elements of the health records you require, along with details which you may feel have relevance i.e. consultant name, location, written diagnosis and reports etc.

Please tick the appropriate box: *

Representative’s Details

 
 
 
 
 
 
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Please provide a copy of proof of identity.

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Acceptable file formats are JPG, PNG OR PDF. The combined file size should not exceed 3MB.

Fields marked with an asterisk (*) are mandatory