Register for Online Services

To register for our online services you will need to complete this form and then visit the practice, bringing  with you two forms of identification. One of these items should include your photograph.

For children up to the age of 11, proxy online access can be granted to their Parents/Carer. Forms are available from the surgery. Between the ages of 11 years and 16 years, Proxy access is not permitted except in exceptional circumstances.

Due to the current situation surrounding COVID-19, our mandatory policy requiring you to present with two forms of identification has been suspended temporally. You are only required to complete this form, please do not bring in ID for the time being. Due to this we are only allowing restricted access, which will allow you to: Order your repeat prescriptions, Make an appointment & Cancel an appointment.

Register for Online Services

Register for Online Services

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Any responses we send will go to this email address.

Address, including postcode:

I wish to have access to the following online services (please tick all that apply):

Booking Appointments

Requesting Repeat Prescriptions

Accessing My Summary Medical Record

I wish to access my medical record online and understand and agree with each statement:

1. I have read and understood the information leaflet provided by the practice

2. I will be responsible for the security of the information that I see or download

3. If I choose to share my information with anyone else, this is at my own risk

4. I will contact the practice as soon possible if I suspect that my account has been accessed by someone without my agreement

5. If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible

6. I understand that my medical record is designed to be used by clinical professionals to ensure that i receive the best possible care. Some of the information within my medical record may be highly technical, written by specialists and not easily understood. It may be best not to access my notes for the first time in the evenings or at weekends, when the surgery may be closed.

Terms and Conditions

I understand that it is my responsibility to keep my account secure by keeping my details confidential I understand that I can terminate my account at any time by contacting the surgery, or change my log in details by re-registering and that this form will be kept on my electronic records I understand that my registration will be revoked if I constantly miss or cancel appointments.

*

I accept the terms and conditions stated above