• Select Language
    • Afrikaans
    • Albanian
    • Arabic
    • Armenian
    • Azerbaijani
    • Basque
    • Belarusian
    • Bengali
    • Bulgarian
    • Catalan
    • Chinese (Simplified)
    • Chinese (Traditional)
    • Croatian
    • Czech
    • Danish
    • Dutch
    • Esperanto
    • Estonian
    • Filipino
    • Finnish
    • French
    • Galician
    • Georgian
    • German
    • Greek
    • Gujarati
    • Haitian Creole
    • Hebrew
    • Hindi
    • Hungarian
    • Icelandic
    • Indonesian
    • Irish
    • Italian
    • Japanese
    • Kannada
    • Korean
    • Lao
    • Latin
    • Latvian
    • Lithuanian
    • Macedonian
    • Malay
    • Maltese
    • Norwegian
    • Persian
    • Polish
    • Portuguese
    • Romanian
    • Russian
    • Serbian
    • Slovak
    • Slovenian
    • Spanish
    • Swahili
    • Swedish
    • Tamil
    • Telugu
    • Thai
    • Turkish
    • Ukrainian
    • Urdu
    • Vietnamese
    • Welsh
    • Yiddish
  • 024 76614255
  • HenleyGreen.Medical@nhs.net
  • Facebook
  • Font Size
    • Increase Font Size
    • Decrease Font Size
    • Reset Font Size
Henley Green Medical Centre
Search
Show Main Menu
  • Home
  • About Us
    • Introduction
    • Opening Times
    • Facilities
    • Practice Staff
    • What people think of us
    • Friends & Family Data
    • Patient participation
    • Policies
    • Carers
    • Violent and Abusive Patients
    • Computer and Test Results
    • Fees
    • Publication of GP Earnings
    • Care Quality Commission Ratings
    • GDPR Privacy Statement
    • View All Pages
  • How do I
    • Access my medical records
    • Repeat Prescriptions
    • Make an appointment
    • Get help in an emergency
    • Obtain test results
    • Register with the practice
    • Provide feedback
    • Request a telephone consultation
    • Request a home visit
    • Keep healthy
    • Obtain a Fitness for Work note
    • Register as a carer
    • Change my Address
    • Get Telephone Advice
    • Get an Appointment Reminder
    • View All Pages
  • Our Services
    • Blood Tests
    • Clinics
    • Vaccination Schedule
    • Travel Information
    • Non-NHS Services
    • Patient Advice and Liason Service
    • General NHS Advice on COV-19
    • Adrenal Insufficiency
    • Underlying Lung Disease
    • People with Asthma
    • People with Diabetes
    • People affected by Strokes
    • Information for Pregnant Women regarding COV-19
    • People with Heart or Circulatory diseases
    • Age Uk Advice for Older People
    • View All Pages
  • Do It Online
    • Online Access
    • Change of Address
    • Consent
    • Feedback for the Practice
    • Join Patient Reference Group
    • Update Clinical Record
  • Contact Us
  • Library
Show Side Menu
  • Online Access
  • Change of Address
  • Consent
  • Feedback for the Practice
  • Join Patient Reference Group
  • Update Clinical Record

Consent

Occasionally you may want someone to be able to discuss your medical records with us. This could be a partner, relative or friend. Please consider this carefully, as if you provide consent for a named person, they will be able to discuss elements of your medical care with us. If you would like someone to be able to discuss your care with us, without us requiring additional consent, please provide their details below.

For children aged 13 and younger, we will only discuss their care with people deemed to have parental responsibility unless otherwise stated.

We reserve the right to refuse access to anyone other than the individual, the medical record pertains to if there are grounds that providing access is likely to cause serious physical or mental harm to the patient or the information you have asked for contains information that relates to a third person.

Your Details

DD/MM/YYYY
Find my NHS Number (opens in new window)

Details for the named person

DD/MM/YYYY
Find my NHS Number (opens in new window)

Does the carer hold legal power of attorney?

If yes please provide a copy of the legal documents to the surgery.

I want the person to be able to discuss


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Back to top

Site

  • Home
  • About Us
  • How do I
  • Our Services
  • Do It Online
  • Contact Us
  • Library

About

  • Sitemap
  • Disclaimer
  • Website Privacy
  • Website Accessibility
  • Cookies
  • Content Attribution
  • Back To Top

Social

  • Facebook

Contact

Henley Green Medical Centre

Henley Road, Henley Green, Coventry, West Midlands, CV21AB

  • 024 76614255
  • HenleyGreen.Medical@nhs.net

© Henley Green Medical Centre 2025

Supplied by Oldroyd Publishing Group • Site powered by GP Fusion

Loading...