Register as a Proxy Patient

Accessing someone else’s information

As a parent, family member or carer, you may be able to access services for someone else. We call this having proxy access. We can set this up for you if you are both registered with us.

To request proxy access:

Print and fill in our proxy access form
Collect a proxy access form from to fill in at reception
Fill the online proxy access form below
Please note that ID must be checked at the practice for authorization to be granted

Linked profiles in your NHS account

Once proxy access is set up, you can access the other person’s profile in your NHS account, using the NHS App.

The NHS website has information about using linked profiles to access services for someone else.

Third Party access to a patient’s personal details (Proxy Patient) Form

Patient's name

First Name

Last Name

Patient's DOB

YYYY

Patient's Adress

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I hereby grant permission for:

To have access to my medical records and personal details held by the practice.

This permission relates to

Where the permission is restricted to part of the record only, please specify below the limits of this permission, and any areas of the records which are excluded:

I understand that this permission will remain in force until cancelled by me in writing.

Accessing someone else’s information

Third Party access to a patient’s personal details (Proxy Patient) Form

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