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Medical Records Access Request Form

You have the right to ask for information held in your medical records by your GP practice. This is known as a Data Subject Access Request (DSAR). There is usually no charge for this.​

 

You can already view much of their information through the NHS App, including test results, letters and consultation notes. It is much quicker to use this option, and you can review many different parts of your record without needing to submit a DSAR request. The information available through a DSAR and that available on your NHS app is not different.​

 

If you would like access to any information held in your records, please complete this form. We usually respond within one month. If you need help completing this form or have any questions, please contact your practice.

Thanks for submitting!

*This form is for Modality Partnership Patients Only and must be completed and signed in order for us to process your request*

Section 1: Your Details

What is the main purpose of your request? (Tick all that apply) Required

Section 2: Purpose of your Request

Section 3: What Records are you Requesting?

Please be as specific as possible. This helps us provide the information quickly and reduces delays.

Sources of information to include: (Tick only one) Required
Proof of ID
Upload supported file (Max 15MB)
Supporting Documentation
Upload supported file (Max 15MB)

​Understanding the purpose of your request helps us ensure you receive the correct information in the most helpful format.

Section 4: How Would you Like to Receive the Information?

Please tick one option: Required

Section 5: Proof of Identity 

To keep your information safe, we need to confirm your identity. Your practice team may be able to vouch for you to confirm your identity. If they are unable to do this, we will require you to provide proof of identity. Please tick one option below to show which type of proof you will provide.

Please tick only one option: Required

Section 6: Declaration

I declare that the information given by me is correct to the best of my knowledge and that I am entitled to apply for access to the health records referred to above under the terms of the General Data Protection Regulations.

I am requesting: (Tick all that apply)

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