Access your own mental health record

Please use the form below if you are a patient wishing to access your own mental health record.

Under the Data Protection Act 2018, we will respond to all applications within 30 days.

We will send records via the NHS secure encrypted electronic process.

Application form

Please complete the form below. The questions marked 'required' must be filled in.

Full name Required

Any previous name(s) you were known by when you were using our services

Date of birth Required

Gender Required

Man

Woman

Non-binary

Prefer not to say

Email address Required

Current address Required

Any previous address you were living at when using our services

Telephone number

NHS number (if known)

Confidentiality

We always do our utmost to maintain the confidentiality of our patients' records.

We require proof of identity to open a request. Please provide a copy of one of the following:

Passport
Driving licence
Birth certificate
Medical card
A letter from the DWP/Jobcentre Plus.

Please also provide a copy of a utility bill showing your current home address.

Proof of identity Required

Proof of address (utility bill) Required

Details of records requested

We will provide the most recent 24 months' worth of records, unless there is a specific time period you require.

Some of the services we provide include: children's health services (in Derby city), children's mental health services (in southern Derbyshire), community mental health services for working age adults and older adults, inpatient mental health services, learning disability services, drug and alcohol support services and gambling support services.

Visit our service finder page for a comprehensive list of our services.

Please note that for physical health records from the Royal Derby Hospital, you will need to contact the University Hospitals of Derby and Burton NHS Foundation Trust.

Date(s) if known

Reason for request

The reason for the request is:

A claim against this Trust and/or its staff

An action against someone else

Another reason

Which services/teams did you access?

Our team can often help to find the information you are looking for more efficiently if you can provide us with more detail about the reason for your request and any key date ranges. Word limit: 500 words

Please ensure all required fields are completed and the privacy policy and email checkboxes below are ticked to avoid receiving an error message - if any of these are missed, you will need to re-add your identity documents. Thank you.

I agree to the privacy policy

If you would like an electronic record of the information you have submitted, please enter your email address

I confirm that the email address above is correct (please tick to confirm)

Contact us

If you have any questions or queries, please email our Records team at: dhcft.accesstoahealthrecord@nhs.net

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