Register for Online Services

To register for our online services you will need to complete this form. You will be requested to upload two forms of identification, one of these items should include your photograph. However, if you are unable to upload two forms of identification, please complete the form and submit your request and one of our Patient Care Advisor Team members will contact you to confirm your identify.

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

Register for Online Services

Register for Online Services

If you are human, leave this field blank.

Section

Address, including postcode:

Online Access

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

Appointment booking

Request medication

Questionnaires

Summary record access

Detail coded access

Full clinical access

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.

Drop a file here or click to upload Choose File

Maximum upload size: 20.97MB

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