NHS App – Individual

Proxy User Form - Accessing Your Own Medical Records

Please complete this form to request access to your medical records. Once submitted, a member of our team will contact you to verify your details and confirm that the request was made by you before processing your application.

Step 1 of 2

Name  Required
Address  Required
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 64 MB, Max. files: 3.

    Before we process your request

    Tick which apply
    I wish to have access to the following information:  Required
    Select exactly 3 choices.
    I wish to have access to my health records online and understand and agree with the following statements:  Required
    Select exactly 6 choices.
    Date  Required
    Full name in CAPITAL LETTERS

    Additional Information

    Carers

    Chaperoning

    GDPR, Data Processing and Subject Access Request (SAR)

    Infection Control

    Long Term Conditions

    Summary Care Records

    Zero Tolerance Policy

    Non-NHS Services

    Patient Participation Group

    Responsibilities

    Talking Saves Lives

    Winter Health

    Community and Locality Services

    Complaints Policy