Application for Online Access

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In accordance with the UK General Data Protection Regulation (UK GDPR)

If a child aged 13 or over has ‘sufficient understanding and intelligence to enable him/her to understand fully what is proposed’ (known as Gillick Competence), then s/he will be competent to give consent for him/herself but may wish a parent to countersign as well.

Please note the practice policy:

  • For patients aged 0-10, a parent/guardian can request proxy access.
  • There is no online access (proxy or otherwise) permitted for ages 11-12 inclusive, any requests for medical records of a child this age need to be requested via a SAR. If you are ordering medication for a child of this age, you may click here to submit your request.
  • From age 13, where the child is deemed Gillick competent, they may request their own online access.
  • We do not permit proxy access for any child aged 11 or over, nor for any person aged 13 or over who is competent to have their own access.

You can now book appointments, order repeat prescriptions and see some of the information in your GP records, including medications and allergies online.
The surgery has a responsibility to look after your GP records. You must also take care online and make sure your personal information is not seen by anyone who should not see it.

Keeping your username and password safe

When you register to use Online Services, you will create your own username and password, which you will use to log in. You should not share your log in details with others.
To protect your information from other people:

  • You should keep your password secret and it is best not to write it down. If you must write it down, keep a reminder of the password, not the password itself. This should be kept in a secure place.
  • If you think someone has seen your password, you should change it as soon as possible. You may want to call the surgery if you are not able to change it right away, for example, when you do not have access to the internet.
  • You should not share your user name or password. No one should force you to show them your log in details, you have the right to say no. If someone forces you, tell the surgery as soon as possible.

Using a shared computer

You need to take extra care when using a shared computer to look at your records online. This could be at the library, at work, at university or at home. To protect your personal information from others  when using a shared computer. 
You should:

  • Look around to see if other people can see what is on the computer screen. Remember, your records contain your personal information.Look around
  • Keep your username and password secret. Just like your bank account PIN you would not want others to know how to get into your records.
  • Make sure you log out when you finish looking at your records so that no one else can see your personal information or change your password without your knowledge.

Incorrect information in your records

On rare occasions information in your records might be incorrect.

  • If you find any incorrect information you should let the surgery know as soon as possible.
  • If you see information about anyone else in your records, log out immediately and let the surgery know as soon as possible.
Details of the Patient
Please double check you've entered the correct email address
Consent to proxy access to GP Online Services

To be completed by the applicant


Should you need additional applicants, please submit another form once completing this one

I/We wish to have access to the health records on behalf of

I/We wish to have access to the following online services

Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
To be completed by the Patient

, give permission to my GP practice to give the following people proxy access


Proxy access will be given to the following online services

  • Booking appointments: 
  • Requesting repeat prescriptions: 
  • Access to my medical records: 
Patients requiring access to their own record
Proxy declaration

You are advised that the making of false or misleading statements in order to obtain personal information to which you are not entitled is a criminal offence which could lead to prosecution.

All applicants need to provide two forms of identification, one of which must be photographic identification before access can be set up.

Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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