Request to register for online services

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

Last Updated: 03/11/2023

My details

Name *

Date of Birth *

Address *

Postcode *

Email Address

Phone Number

Online services request

I wish to have access to the following online services (choose all that apply): *

Booking appointments

Requesting repeat prescriptions

Accessing my medical record

If you wish to access your medical record, is there a specific area or piece of information you wish to access?

Terms and conditions

To access your medical records online, we ask that you read through, understand, and agree to each of the following statements.

Identity verification

In order to complete your online services registration, we need to verify your identity. There are a few ways that we can do this. Please provide an answer to TWO of the following questions.

Can you provide your NHS number?

When did you last attend the surgery? Who did you see?

Can you name a medication that we currently prescribe for you?

If you are unable to answer TWO of the above questions, please attend the surgery with some identification.

I will attend the surgery with identification so that the surgery may verify my identity

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Request to register for online services

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