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.

Date of birth Required
Gender Required


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.


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.

Reason for request

The reason for the request is:
Word limit: 0 / 500

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.


Contact us

If you have any questions or queries, please email our Records team at: