Reception / Administrative Services

I would like to:

Change the Address / Contact details on my Medical Record

It is vital that you keep your medical record up to date, in the event of an emergency.

Use the form the let us know of changes to your Name, Address, Telephone Number and / or Email address.

Request a copy of a Medical Record

With online access via the SystmOne Airmid app you are able to see your medical record. Register now for online access if you currently do not have access.

Request a Maternity Exemption from Prescription Charges Certificate

Please visit Reception and collect a FW8 form.

Once completed return it back to us, a midwife will sign the form and we will post it off for you

Request a Medical Exemption from Prescription Charges Certificate

Please visit Reception and collect a FP92A form.

Once completed return it back to us, a GP will sign the form and we will post it off for you

Request Online Access to my Medical Record
Request Online Proxy Access (Access to the record of someone else you care for)
Request a University Letter

To request a University letter please download the below form.

There is a charge to the University for providing these letters and therefore prior payment approval needs to be given by the University before any letter is released.

How to obtain a letter :-

  1. Complete part A of the form overleaf yourself and then pass it onto your tutor requesting the letter.
  2. Your tutor must complete part B stating what information they require.  Your tutor must then pass the form onto the Student Welfare Service for approval. 
  3. Once Student Welfare have completed part C and given their approval return the form back to us. This can be returned to us using the form below.
Request for the completion of a University Letter

Patient’s Details

Include Flat, Room, Block Number and House Name
Enter Email
Confirm Email

Privacy Policy

Maximum upload size: 5MB
If you DO NOT have the form digitally please hand to Reception as soon as possible. We accept pdf files only, up to a total upload size of 5MB. If completing this form using a smartphone or tablet download a ‘PDF Scanner’ app to take pictures.
Upon the completion of request how would you like to recieve the documentation

Agreement

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This service is intended for electronic communication between you and your Practice. The information may be read by any member of the Practice team and responded to by the most appropriate member of the team. Your Practice will endeavour to respond within the time frame set for this form but will not be able to respond to urgent requests through this service.