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Manor View Practice logo featuring the letters MVP stylised with a stethoscope motif and rainbow colour bar.

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Medical Information Release Consent

Your Rights

Only you or someone you choose can access your medical information. If you want to authorise someone else to receive information from your medical records, you must fill out the consent form below to give us permission to share this information.

Allowing Access To Your Medical Records

Please fill out the consent form below to authorise us to share your medical information with your chosen representative.

Medical Information Release Form

Consent form to allow your GP to release medical information


Details of nominated representative that you authorise medical information will be shared with


Privacy Policy

Please note that we will not respond to any medical information or questions received through the survey.

The information you supply us will be used lawfully, in accordance with GDPR Regulations. GDPR gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.

Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration.

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.  

Please read our Privacy Policy to discover how we protect and manage your submitted data.