Third Party Consent to Allow Access to Medical Records

Please complete this form if you wish to grant a representative the ability to communicate with us about you.

This will enable them to gain information about you, and your medical problems, talk to us about your care and give and receive information about you. It will not entitle them to order copies of your medical records, sign consent on your behalf, withdraw care or sign an order to prevent your resuscitation.

Giving consent to someone else to communicate with us about you and your medical problems is a very significant step and you should give it serious consideration before you give consent. You need to consider what they might learn about you and your problems that you did not want them to know, and have fully considered the ramifications of giving consent.

If you are unsure about giving consent, we advise that you do not give it and that you seek legal advice before proceeding.

Next Steps

You may receive a telephone call to confirm this access request from a member of our administrative staff; this is to ensure any requests are made with the knowledge of the individual.

Access can be denied by the surgery should a member of the clinical team feel this request has not been made with the patients best interests at heart, this can be revoked by the surgery at any point.

You may also revoke this consent to share information with third parties at any point. You do not need to inform your representative of this.

Confirmation of this account being activated will be sent back via email, you must ensure you routinely check your emails for surgery correspondence.

“Do not contact your GP surgery about your COVID-19 vaccination status. GPs cannot provide letters showing your COVID-19 vaccination status.”

We are unable to issue this certificate at the practice.

Please see Demonstrating your COVID-19 vaccination status when travelling abroad – GOV.UK ( for further information.

Proof of your vaccination status will be available on the NHS app, which is also valuable for accessing your health records and ordering repeat prescriptions.

The NHS app can be downloaded from here ‎NHS App on the App Store ( for iPhone or here NHS App – Apps on Google Play for android.

Alternatively, you can call the NHS helpline on 119 from 17th May and ask for a letter to be posted to you. This must be at least 5 days after you’ve completed your course of the vaccine; the letter may to take up to 5 days to reach you.”