Access your mental health record

Each time you have an appointment with us, we'll update your personal records with updated information about you and your treatment.

Sometimes, you may wish to access this information to check they are accurate or to find out background information about your care.

You can use this form to request access to your own mental health record. Please enter as much information as you can as this will allow us to deal with your request effectively.

If you are requesting someone else's information, please contact us here rather than completing this form. Similarly, if you are having difficulty submitting this form, please contact us.

Access your mental health records

Surname Required

First name(s) Required

Any previous name(s)

Date of birth Required

NHS number (if known)

Current address Required

Postcode Required

Email address Required

Telephone number Required

Please tick this box if you are happy for us to leave messages at this number, if necessary

I am happy for you to leave messages at this number

Confidentiality

We always aim to maintain the confidentiality of our patients' records.

Unless you are currently an inpatient with us, we will require you to send us proof of identity by attaching or enclosing a copy of:

Your medical card, drivers license, birth certificate, passport or a letter from the DWP
AND
A utility bill showing your current home address.

Photos of the above documents taken on mobile phones are acceptable.

Proof of identity Required

Utility bill with current home address Required

Please list the documents you have attached above. Required

Details of records requested

We understand it might be hard to remember everything accurately - particularly dates and names - but please provide details about the records you are requesting access to.

Dates (if known)

Which teams were you seen by?

Data Protection Act 2018

In line with the Data Protection Act 2018, we will aim to respond to all requests within one month, however if a request is complex we can take up to three months.

There will be no charge for the application, unless it is deemed excessive or repetitive. In these cases, an administration fee may be charged.

Please read and agree to the terms of the privacy policy Required

I have read and agree to the terms of the privacy policy

If you are struggling to submit this form, please call (01472) 583040.