Proxy Access to Online Services

To register for our online services you will need to complete this form.

Due to the current climate, as a temporary measure, we are currently accepting copies of ID electronically or posted.

Please note we need to verify your identification and residency. You will need to come into the Surgery in person within 7 working days, with one Photo ID such as valid passport or drivers’ licence and with proof of residence, such as a utility bill addressed to yourself dated within the last 3 months.

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 summary record, medications and known allergies
  • View your test results (subject to the GP’s discretion)

Your registration will not be processed until you have provided the required documents. If we have not received the requirements within 7 days your request will be deleted from the system.

Proxy Access to Online Services

Patient Details

Please use date format: DD/MM/YYYY

Patient Consent

I give permission to the practice to give proxy access to online services as indicated below:

  • I reserve the right to reverse any decision I make in granting proxy access at any time.
  • I understand the risks of allowing someone else to have access to my health records.
  • I have read and understand the information leaflet provided by the practice.
I wish to allow online access to (please select all that apply):

Proxy Details

Please use date format: DD/MM/YYYY

Please use date format: DD/MM/YYYY

Proxy Agreement

I/we wish to have online access to the services authorised by the patient.

I/we understand my/our responsibility for safeguarding sensitive medical information and I/we understand and agree with each of the following statements:

  • I/we have read and understood the Online Access for Patients – Important Information and agree that I will treat the patient information as confidential
  • I/we will be responsible for the security of the information that I/we see or download
  • I/we will contact the practice as soon as possible if I/we suspect that my account has been accessed by someone without my/our agreement
  • If I/we see information in the record that it not about the patient or is inaccurate I will log out immediately and contact the practice as soon as possible. Any information which is not about the patient will be treated as being strictly confidential

Please bring photographic proof of your identification in order for the sign-up process to be completed