Subject Access Request Form

Application for access to records under the General Data Protection Regulations 2018, the subject access provisions of the Data Protection Act 2018 and the Access to Health Records Act 1990 Leicestershire Partnership NHS Trust provides integrated mental health, learning disability and community health services in a variety of settings. To help us locate the health records you require please provide as much information as possible.
  • For example previous surnames, or names the patient preferred to be known as
  • I declare that the information in this form is correct to the best of my knowledge and that: