Consent to proxy access

Use this service to provide consent for proxy access to medical records.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of
• two forms of identification (one for proof of identity and one for address)

Start now

You can also phone us on 020 8854 3964.