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.
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