Subject Access Request Form

Please complete this online form as well as sending a copy of your proof of ID – Passport or driving licence photo to the practice email address.

Please note under the terms of GDPR the timescale for providing copy records is one calendar month from the date we receive your request.

Name

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Date of Birth

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Address

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Phone number

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ID Upload

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From

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Buckley Medical Centre:
Monday - Friday: 8 am – 6.30 pm
Saturday - Sunday: Closed

Glanrafon Medical Centre - Mold:
Monday - Friday: 8 am – 6.30 pm
Saturday - Sunday: Closed