Register for Online Services Home Register for Online Services Back to Home Register for Online Services Register for Online Services To register for our online services you will need to complete this form and then visit the practice, bringing with you two forms of identification. One of these items should include your photograph. We will then issue you a username and password. Register for Online Services Name Date of Birth For example, 15 3 1984 Day Month Year Phone Number Email Address Address Postcode Which online services would you like access to? (tick all that apply) Order Repeat Prescriptions Make an Appointment Cancel an Appointment Change personal details Review your medications and known allergies View Medical Records 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 consent to the practice collecting and storing my data from this form. Submit Form Oops… There was an error contacting reCAPTCHA, Please try again. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Page last reviewed: 13 October 2020 Page created: 20 March 2023