Third Party Access Requests
If you wish to give access to your medical records and information to a named third party, please fill in this form and return it to the surgery.
PLEASE NOTE: you (the person allowing access) will need to attend in person with identification in order for us to set this up for you.
Third party consent form
** Covid change: as we are currently only allowing access into the surgery for booked appointments, please scan/photograph your completed third party consent form and email it to: email@example.com. Please attach a photograph of yourself holding photo ID - this photo will be used for ID verification purposes only, will not be stored on any systems/medical records and will be deleted once processed. One of our team members will then call you for further identity verification. Thank you for your continued co-operation and understanding in allowing us to provide the best care and support possible to all of our patients. **