Register for Online Services Form

Please note: If you wish to register for online services to access your repeat prescriptions, appointments etc., you are required to provide evidence of identification. Once this has been verified, we will issue the necessary documentation. If you have any further questions please contact the Practice.

Register for Online Services with ID
Please use format day/month/year e.g. 12/05/1979
I agree that my Patient Access login details are sent to the mobile details above. Please note the number must match the one on the patient’s records. We will contact you first for verification.
I wish to have access to the following online services *
Please tick all that apply

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

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, that is at my own risk *
If I suspect that my account has been accessed by someone without my agreement, I will contact the practice as soon as possible *
If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible *
If I think that I may come under pressure to give access to someone else unwillingly I will contact the practice as soon as possible *

Evidence of Identity

To register for Online Services we need to verify your identity. Once we received your application form, we will contact you and send you a text which will allow you to reply with a CLEAR photo of yourself holding a photo ID document ( passport; EU card; drivers license) where your name can be clearly seen and another photo with your home address on such as a recent utility bill or bank statement. This will be processed within 3 working day.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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