Register for Online Services

To register for our online services you will need to complete this form, attaching identification documents, including Photographic ID and proof of address.

We will then issue you a username and password.

Once you are registered you will be able to use the service to order prescriptions and view your summary.

Please upload all documents in an image format such as JPG or PNG.

Register for Online Services

Register for Online Services

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Any responses we send will go to this email address.

Address, including postcode:

I wish to have access to the following online services (Please select all that apply):

Online appointment booking

Online prescriptions management

Viewing Summary Care Record (Sensitivities, Allergies and Medication)

Terms and 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.

*

I accept the terms and conditions stated above

To complete your registration please upload proof of identity, this should include Photographic ID and proof of address.

Drop a file here or click to upload Choose File

Maximum upload size: 20.97MB