Subject Access Request

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You have the right to see your patient record, with the exception of third party information (names of other people and information relating to them) and anything that the GP may consider inappropriate for you to see (this is a rare circumstance). It may take up to 2 working months (but more likely up to 30 days) to receive your full record as the data must be checked before it is released to you.

Under the General Data Protection Regulation (2018), you are entitled to a free copy of your record in a way that suits you. Please answer the questions below so that we can provide this.

Patient Details

Please double check you've entered the correct email address

You can have access to your Online Record from your own home computer using Online Access. From November 2022 this will include all your letters, test results, vaccinations and consultations, and allow you to order repeat prescriptions. Only key parts of your paper records are summarised digitally.

Would you like to be signed up for Complete Online Record Access?: *

Please speak to the Receptionist who will start the process for you. Please note that this can take up to 2 weeks to complete.

As you are going to contact reception to sign up for Complete Online Record Access you no longer need to submit this form: *

Subject Access Request

How much of your medical record do you wish to see?: *

What information do you want included in your copy of your record: *

How would you like to receive your record: *

Guidance for Receiving Emails from Brocklebank Primary Care Network

Email cannot be used to make appointments. The emails are being administered by admin staff so are not an opportunity for an online medical consultation .
Emails are classed as records and will be included in a Patient's notes.
It is the Patient’s responsibility to keep and provide an up to date email address. Brocklebank Primary Care Network will not be held responsible for onwards use or transmission of any email message once it has been received by the Patient.
Brocklebank Primary Care Network strongly recommends that the Patient uses a private email account, not a family or shared account, for the purposes of communication with the practice. However, this is your decision and we cannot insist on use of a private account. Please be cautious of leaving email accounts ‘logged in’ on Smartphones.
Emails will only be sent from a generic practice account, not a named staff account. Use of generic accounts ensures that emails can be accessed and actioned by multiple members of staff, providing cover in the event of absence. The Secretaries, Practice Manager and Senior Reception staff at Brocklebank Primary Care Network will have access to the account.
Internet email accounts, such as those commonly used by individuals for private purposes, are not secure. The Patient is advised that there is a risk (however small) of the email being intercepted or ‘hacked’.
Patients can change their preferences at any time and without having to give a reason. Requests to cease using email will be actioned accurately and in a timely manner (where possible, immediately).

Please email this to : *

We will send requested records to

Please return to the top of this form to make any adjustments to your email address

Privacy Consent

This form collects personal and medical informanot tion about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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