Due to patient confidentiality, we are unable to discuss any aspect of a patient’s medical file with anybody other than the patient, without express consent, except for a parent of somebody aged under 16 or someone holding a Power of Attorney. However, a Lasting Power of Attorney will ONLY come in effect when the patient looses capacity to provide valid consent.

  • If you would like to consent for someone else to be able to discuss your medical records with practice staff, please complete & submit a separate form. 

PLEASE NOTE: This form must be completed and signed by the patient giving permission for access to their record. Any incorrectly completed forms will not be processed.

About You (the patient)

Next of Kin/Emergency Contact (if different from above):