Request of Medical Records

Are you aware that you can see your medical records / results and documents including requesting repeat medication on your NHS App

This option is for one off request of redacted medical records for insurance reports or other reporting reasons.

Please note that we process within 30 days of receipt of this request fully filled in.

Please make sure that you provide correct email address as copies of notes are provided in PDF format send via email.

First Name

Surname

Date of Birth

Full postal Address

Email Address

Contact Telephone Number

Reason for Requesting Copies of Notes Please give us brief description of reason for requesting copies of medical notes

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Willenhall Oak Medical Centre • Willenhall Oak Medical Centre, 70 Remembrance Road, Coventry, CV33DP.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.