Information request form (SAR)

Information request form (SAR)

Use this form to request -

  • Copies of results requested by the practice
  • Copies of you GP surgery records
  • Letters from the GP
  • Insurance reports
  • Other private work
  • Other Subject Access Requests (SAR)

  • Access personal data

    You can also use this form if you are making a request on behalf of someone else, however in such instances we will ask you to provide evidence of your entitlement to act and receive information (please ensure you complete section 3) or will seek authority from the individual for whom you have made the request.

    Some requests are private work and will be chargeable.

    You will not be charged for a copy of your records. However, the Practice can charge a “reasonable fee” when a request is manifestly unfounded or excessive, particularly if it is repetitive (e.g. requesting the same information more than once in a 6 month period). We will therefore charge a reasonable fee to comply with requests for further copies of the same information.

    If you have any queries relating to your request, please contact us -

    • email contact.w92025@wales.nhs.uk
    • call 01970 613 500 and choose option 3

  • Section 1: Details of the individual for whom the request relates

    Date of Birth
    For example, 15 3 1984

  • Section 2: Whose personal data are you requesting?

    Please select which of the following applies:

  • If you are not requesting access to your own personal data, please provide the following information about you:

    PLEASE NOTE:

    We are unable to respond to your request until we also receive the following:

    • Satisfactory confirmation of the identity of the person on whose behalf you are making this request. Please provide details outlined in section one.
    • A copy of your legal authority to make this request.  This may be a signed letter of authority, a power of attorney document or other legal document confirming you are their legal representative
    Date of Birth (optional)
    For example, 15 3 1984

  • Section 3: What data are you requesting?

  • Section 4: Declaration

    I declare that the information given in this form is correct to the best of my knowledge and that I am entitled to apply for access to the records referred to under the terms of the General Data Protection Regulation 2016, Access to Records Act 1990 or the Mental Capacity Act 2005.

    Please check the information you have provided and sign below:

    Date
    For example, 15 3 1984
    How would you like your information? We can only give information directly to the requestee.
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Page last reviewed: 02 March 2026