Register for Online Services

Please read the Registering for Online Services – Important Information before submitting this form.

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.

We will then issue you a username and password.

Once you are registered you will be able to use the service to:

Order your repeat prescriptions
Make an appointment
Cancel an appointment
Change your contact details
Review your medications and known allergies

If you are human, leave this field blank.

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

Application for online access to my 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

Terms & 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

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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Register for Online Services