• Bring your records to St Ives Doctors

    Welcome to St Ives Doctors. Tell us where your records are held and we will do our best to request a copy from your previous practice. There is no charge from us. We will also email you a copy of this form. It can help to print it and take it to your previous practice yourself.

  • 01 WHOSE RECORDS ARE THESE

  • Whose records would you like us to request?*
  • What gives you authority to ask for these records?*
  • We may get in touch to confirm your authority. For a child or young person, we may also ask for their consent.

  • 02 PATIENT DETAILS

    So your previous practice can find the right record.
  • Date of birth*
     - -
    2 digit day, 2 digit month, 4 digit year

  • 03 CONTACT DETAILS

    So we can keep you updated.
  • Format: 0000 000 000.
  • Best way to contact you*
  • Do you have an appointment with us coming up?
     - -
    2 digit day, 2 digit month, 4 digit year

  • 04 PREVIOUS PRACTICE

    Tell us who holds your records. Share as much as you can. Fields marked * are the ones we need to make the request.

  • 05 RECORDS TO REQUEST

  • If your previous practice charges a fee, you pay it directly to them.
  • What would you like us to request?*

  • 06 AUTHORITY AND SIGNATURE

  • Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • We may get in touch to confirm your identity before we make the request. If you change your mind, just email records@stivesdoctors.com.au.

  • PRIVACY

  • St Ives MC Pty Ltd trading as St Ives Doctors uses the information in this form to verify identity and authority and manage the requested record transfer. We may share the relevant request details and authority with the practice named in the form. If information needed to process the request is missing, we will contact you. Our Privacy Policy explains how we handle personal information and how to request access or correction or raise a privacy concern. For help, email records@stivesdoctors.com.au.
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