Consent to Send Health Records to a Third-Party

 
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Access to Health Records

Releasing health records under the General Data Protection Regulation and the Data Protection Act 2018

What is this form for?

  • If a third-party has asked for us to send them information from your heath records, you must give us permission to do so.

Want a copy of your own health record?

As private work does not come under NHS general medical services there may be a charge. Should you want to make payment using BACS please use your date of birth as your
reference. 

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Personal Details
  
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Request Details
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
 
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Third-Party Details
Please select which service the request came from: *
Would you like to review the private work before we send it to the third-party?: *

We will send you the work which you will need to confirm before we send it to the third-party

We will send the work direct to the third-party, but we can still send you a copy if you wish

Would you like a copy of the work?: *
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Consent

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Providing NHS Services

Contact

Bridge Street Medical Centre
2 All Saints Passage
(Off Bridge Street)
Cambridge
CB2 3LS

Telephone: 01223 652 671

The Practice

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