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Medical Records Authority

Authority For Release Of Medical Records

Personal Details
 


GP Details

If you have attended more than one GP surgery please supply their details by adding an additional GP surgery below:

 


Hospital Details

If you have attended more than one hospital please supply their details by adding an additional hospital below:

 


I HEREBY AUTHORISE AND REQUEST YOU to forward copies of my full and unexpurgated medical records to SK MEDICAL PRACTICE, SK House, 7 Tapton Way, Wavertree Business Village, Liverpool, L13 1DA.

I confirm that no litigation is contemplated against you or any other member of your staff.