Request for copies of medical notes Request for copies of medical records First Name * Last Name * Date of Birth * Address Line 1 * Town / City * Postcode * Phone * I would like (please tick) * Medical records for the last 5 years Medical records for the last 10 years Full medical records or Notes from Notes to Copies obtained in relation to legal, benefit or employment purposes may have longstanding processes in place to allow the appropriate agencies to obtain this information (with the appropriate consent) which avoids a direct request. Please tick here to electronically sign this request. * I agree Details of what the information is required for. * Submit If you are human, leave this field blank.
