Important: For third party use only

This form should only be completed by by a professional or third party on behalf of their patients/clients, who are registered patients of The Delamere Medical Practice.

If you are a patient or need to contact us directly, you can phone us on 0161 864 0200.

Third Party Request

Patient Details

Any responses will be addressed to the patient.
Any responses we send will need to be accessed and viewed using the patients DOB.

Requester Details

Any responses we send will go to this email address.

Please note, any information submitted by a third party via this form will be added to the patients clinical record and can be viewed by the patient at any time.