Form for Data Subject Access Request

If you want us to supply you with personal data we hold about you and to which you are entitled to access under the Data Protection Act 1998, please complete this form and send a cheque/bankers draft for £10, payable to Midland Heart Limited, to: The Data Protection Team, Midland Heart, 20 Bath Row, Birmingham, B15 1LZ.

We will provide you with the required information within 40 days of receiving your cleared payment and form below.