Historical Medical Information Request

Please use this form if you are a patient wishing to see their historical medical information on their NHS app.

MY DETAILS

Name, date of birth and address information

First Name *

Last Name *

Date of Birth *

First line of your home address *

Mobile telephone number *

Email address *

CONFIRMATION OF REQUEST FOR HISTORICAL ACCESS

By continuing, you are requesting that the practice release your historical medical information to be viewable to you on your NHS app. This may include information you have forgotten about, or may find upsetting.

Do you wish to have your historical medical records viewable on your NHS App? *

Yes No

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Page last reviewed: 22 October 2026
Page created: 22 October 2026

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Historical Medical Information Request

Historical Medical Information Request

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