Patient consent form for detailed coded record access

You may view your GP medical record online to look at test results, details of consultations and your medical history, including current and past medication.

If you would like to have secure online access to your records, we need to make sure that you understand what this involves and that you are happy for us to use the information about you, that you provide, to set up the and operate the service.

The following service will take you through the things you need to think about. By completing and signing the form, you will be giving us your permission to go ahead with setting up the service for you. If you decide not to join, or wish to withdraw, it will not affect your treatment in any way.

Access is granted at the discretion of the practice. You will be informed if access cannot be granted.

You can use this service if you:

Before you start

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of
Start now

You can also phone us on 0118 940 3939.