Register for online services

Section

Address, including postcode:

Online Access

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

To complete your registration please upload proof of identity, this should include Photographic ID and proof of address. If you cannot attach your ID, you will need to come into reception to show this.

Maximum upload size: 8.39MB

Terms and Conditions

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

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.

For Practice Use Only

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Section

Online Access

Terms and Conditions

For Practice Use Only