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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 time. These are not processed as urgent.

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

You will be contacted upon its release.

Historic Electronic Record Access Request
Please use format day/month/year e.g. 12/05/1979
Confirm your request

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
How will you provide evidence of ID and address?

Upload documents

Maximum file size: 10MB

Maximum file size: 10MB

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.