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Information Sharing Consent Form

If you would like a family member or carer to have access to your medical records on your behalf, please fill in this form and return it to reception at the Surgery or e-mail it to

Information Sharing Consent Form

Online access to someone else's records (teenage child, spouse, parent, someone you care for) can be arranged and is called Proxy Access.

You will need to download this form and the person granting access should come to the surgery. If that is not possible, then please provide and explanation but the person seeking access will have to come. 

We are giving access to confidential patient data and this is not just an IT issue. it is a data control and confidentiality issue.

Request for Proxy Online Access

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