Proxy Access Form




Please visit the surgery to collect a Proxy Access Form

Before the practice provides proxy access to an individual or individuals on behalf of a patient, an authorised member of staff at the practice must satisfy themselves that they have the explicit informed consent of the patient. To do this the patient must complete a Proxy Access Form which can be collected from you Surgery.

Adult patients with capacity may give informed consent to proxy access to the practice records about them. People aged 16 or above are assumed to be competent unless there is an indication that they are not. Young people under the age of 16 who are competent may also give consent to proxy access.

The person requesting proxy access to someone else's records should already have set up online access to their own medical record.