Register for online services

Address, including postcode:

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

Booking appointments

Requesting repeat prescriptions

Accessing my detailed coded medical record

I wish to access my medical record online and understand and agree with each statement (please tick): *

I have read and understood the information on the Important Information page

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

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

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

If I see information in my record that it not about me, or is inaccurate I will log out immediately and contact the practice as soon as possible

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

Signature: *

Date:

I accept the terms and conditions stated above

To complete your registration please upload proof of identify, this should include Photographic ID and proof of address.

Maximum upload size: 67.11MB

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