Please fill in this form and return it to your surgery.
CONSENT FOR RELEASE OF MEDICAL DETAILS
Please allow a minimum of seven working days for this request to be processed and for the letter to reach your department. Letters may be done sooner in exceptional circumstances only.
COMPLETING THIS FORM MEANS A LETTER WILL BE SENT TO YOUR DEPARTMENT. IT IS YOUR RESPONSIBILITY TO CHECK THAT THIS INFORMATION MEETS THE REQUIREMENTS OF YOUR DEPARTMENT