Register for Online Services

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 have read and understood the information leaflet provided by the practice
  • 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, this 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.

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.