Consent to Full Medical Records Access

I am a patient of Needham Market Country Practice and understand I need to give consent for another individual to have access to my medical records, and/or to discuss my medical requirements. I understand the contact details of the individual will be recorded on my medical record.

Please Note:  We require ID from both the patient and the patient’s representative who is gaining consent to be uploaded.

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.