Register for Online Services Form

To register for our online services you will need to complete this form and attach two forms of identification. One of these items should include your photograph. 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 medications and known allergies

Register for Online Services

About You

Your First Name(s)

As it appears on your passport.

Your Last Name

As it appears on your passport.

Postcode

The one used to register with your GP.

Your Date of Birth

Your date of birth is required to verify your identity.

Gender

Male

Female

Non-Binary

Prefer Not To Say

Your Phone Number

This phone number will be used for all correspondence relating to this request.

Your Email

This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Address

Street Address Optional Address Line 2 Optional City Optional Postcode Optional

Full address, including postcode

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.

Identification Optional

Max. file size: 50 MB.

Please attach two forms of ID to complete your registration