Bennfield Surgery
Bennfield Surgery
Bennfield Surgery
Bennfield Surgery 

Patient services

Patient Third Party Consent form
Patient third party consent form - April[...]
pub File [103.0 KB]

Patient Third Party Consent


You may wish to authorise a representative to speak to the practice on your behalf regarding your medical information.


In order to do this, we require you to complete and sign the form below and return it to the Surgery. You will need to bring with you a form of ID, usually your passport, driving license or birth certificate. If you do not have these documents, please speak to our Reception team about suitable alternatives. We are unable to process your request without sight of your ID.


This will allow your representative to communicate with us about your medical records/information. It will enable them to gain information about you and your medical problems, talk about your care, and give and receive information about you. This includes any unforeseen new medical information. 


The consent does not allow your representative to gain copies of your medical records, sign any consent forms on your behalf, withdraw your care or sign an order to prevent your resuscitation. 

How to contact us

Bennfield Surgery

Hilton House

Corporation Street


CV21 2DN


Tel: 01788 540860


Opening hours: 

Monday-Friday, 08:30am - 06.00pm


Prescription requests:

Order your prescription online here.


Do we hold the correct contact details for you? If not, please contact Reception 

We are unable to book appointments via email. Please either phone the surgery or come in to the surgery to book your appointment. 


Out of Hours

Outside of normal working hours, please contact the NHS out of hours service by phone on 111. 


NHS 111 can help if you need urgent medical help or if you’re not sure what to do. They will ask you questions about your symptoms, so you get the most appropriate help. You can also get help from their website:


In the event of a medical emergency call 999





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