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Castlegate & Derwent Surgery Isel Road, Cockermouth, CA13 9HT Tel: 01900 705750

There may be circumstances that you wish for another individual to gain access to your medical record. This would allow the named person to speak on your behalf to a member of our team about your medical requirements and have access to your medical record. 

If you require this to be arranged we request that you complete the form below and hand into our Reception team who will add the contact details of the named individual to your medical record.

Click here to download the Consent Form- for another individual to gain access and / or to discuss my medical record 


If you have a change to your named individual or you wish to remove the person from your medical record, we will require you to complete a 'change/ remove consent form' that should be handed into our Reception team to update your medical record.

Click here to download the Remove or update of consent form 

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