Equalities data collection form

The Race Relations Amendment Act 2000, the Disability Discrimination Act 1995, the Disability Discrimination Act 2005 and the Gender Equality Duty (GED) of April 2007, requires us to make sure all our policies, practices, services and functions are fair and none of them create barriers for particular racial groups or disabled people.  We would therefore be grateful if you would complete the following form: 

If you have any queries or need help with completing your application please do not hesitate to contact us either by telephone or by email:

Direct dial: 01332 623760  Switchboard: 01332 623700 ext 33760

Once completed you can either email your form attaching any relevant documents or post to us:

e-mail: accesstoahealthrecord@nhs.net

Postal address:
Access to a Health Record 
IM&T and Records 
Kingsway House East 
Kingsway site 
Derby

DE22 3LZ