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Your information
For your request to be dealt with under Freedom of Information, please give your name and contact information below. Please note, this form is not to be used for requesting medical records. If this information is required, please go back into the Trusts website and using the 'search bar', input "request medical records".
Your details, as you have indicated you are not the Patient
Please attach a copy of the patient’s written consent/legal document authorising you to request information on behalf of the patient.
Or
Reporter
The field above is for the Staff Lookup
On Behalf of (Staff)
Request DetailsMore
Please complete all relevant fields, the ones in orange are mandatory and MUST be completed for this form to be saved.
Request wide location info
Please detail your request for information below
Click the NEW button for each individual question you would like to request information for. Please note that in order for us to be able to process your request for information, please clearly document what information you are after with any additional information such as time frames.
record unique Question? Del.
Please attach any relevant templates or documentation to your request. Please note that we are unable to process any documents that are saved as a pdf
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