Please complete the information to log a request on behalf of a data subject or their representative.


Patient
Employee
Solicitor/Legal Representative/Insurance Company
Health or Social Care Provider (i.e NHS Trust, Social Worker, Private healthcare provider, Consultant, Medical Secretary)
Police Request
Local Authority Request
Fraud Agency
Please ensure you write first name and surname.
Enter email for correspondence with the data request.
Enter any additional information in this section that will help us process your request. Please refrain from entering any personal information.
To maintain security - please provide two pieces of ID . List 1 Passport/National ID Card/Photo driving licence and List 2 Council Tax or Utility bill showing current home address. Please select both documents together to download. Solicitors - To submit a Form of Authority