Medical Report Request Medical Report Request If you would like to request a medical report, please use this form. Your DetailsFull Name Date of Birth Day Month Year Phone NumberEmail Address Enter Email Confirm Email Named GP (if known) Optional ReportWhat type of medical report would you like? Occupational Health Advice HGV/PSV Medicals Taxi Medicals Other Why do you need this report? THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA I consent to the practice collecting and storing my data from this form.