To: The Practice Manager
Surgery name: ______________________________
Date: ____ / ____ / ________
Request for my medical records for taxi or private hire licensing
I am applying for, or renewing, a taxi or private hire driver licence. My licensing council needs information from my GP records. Under my right of access (UK GDPR Article 15), please provide:
☐ a summary of my medical record (problems, medications, allergies and significant past history)
☐ my full medical record
☐ other, as listed by my council: ________________________________
Please provide this ☐ on paper ☐ by secure email to: ______________________________
Full name: ______________________________________
Date of birth: ____ / ____ / ________
NHS number (if known): ______________________
Address and postcode: ______________________________________________
Mobile: ______________________
Signed: ______________________________
GP surgeries normally respond within one month and this is usually free. I will bring photo ID to collect.