Freedom of Information and Environmental Information Regulations request form

This form is designed to help you when requesting information under the Freedom of Information Act 2000 or the Environmental Information Regulations 2000.  You do not have to use this form, but if you do this will help us to deal with your request.  Please note that our CCG will need the information shown below regardless of whether you use this form. Please see our Freedom of Information/Environmental Request Guidance Notes which may help you with your request.

Applicant details

Full name*


Email address*

How would you like us to respond to you?*

These must be supplied although the address can be either postal or email, or both.


Please state the purpose for which the information is to be re-used

Details of request

Please provide as much detail as possible in order to help us find the information you want. Please refer to the accompanying notes to help you clarify your request.

Format of information

Please select

Please specify the format you want us to use when sending you the information. (electronic, paper copy, , DVD, CD etc). Wherever possible, we will endeavour to supply the information in the format of your choice, although there may be a disbursement fee for a particular format.

Other (please state)

Email 2*:

* required fields



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