Non-NHS/Private Work

 
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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 health records, you must give us permission to do so.

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.

To verify your identity, we need you to upload an image of yourself with official photo ID, such as a passport or drving licence. 

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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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Verify Your Identity

To verify your identity, we need you to upload a photo of yourself with your official photo ID such as a passport or driving licence. Your data is secure and this photo is strictly used for verification purposes only.

Tips for taking your photo
  • Use a well-lit room to avoid glare and shadows
  • Sit or stand against a plain, light background
  • Remove any hats or sunglasses
  • We only need a photo of your face and head, from the shoulders up
  • It may be easier to get somebody else to take the photo of you
  • Hold your ID next to your face without covering any text or your photo
  • Keep the ID steady and close enough to the camera so the text is readable
Only following file extensions are allowed: jpg, jpeg, png, webp
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Consent

Privacy Consent

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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

Quick Links

The Care Quality Commission Inspected and rated Good
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