Online Access to Medical Records More information For more information about keeping your healthcare records safe and secure, we recommend that you read Protecting your GP Online Records and this helpful leaflet produced by the NHS in conjunction with the British Computer Society: Keeping your online health and social care records safe and secure Name First Last Date of Birth Day Month Year Address Street Address Address Line 2 City Post Code Telephone NumberMobile NumberEmail Enter Email Confirm Email I understand that my email address and/or mobile number may be used by the practice to contact you to provide health and care services. For example:- appointment reminders health campaign messages messages relating to your own health and care e.g. test results surveys about our services If you consent to be contacted by either of the following please tick: Email Mobile I do not consent I wish to have access to the following online services (please tick all that apply): Booking appointments Requesting repeat prescriptions Sending secure messaging Access to detailed medical record Proxy Access to records for family members who I care for with separate login details Select AllI wish to access my online services and understand and agree with each statement (tick) I have read and understood the information 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 If I see something in my records that I am unsure of and have not yet been contacted by the surgery, I will wait until usual opening times and not contact the out of hours or emergency services Select AllUpload your ID Drop files here or Select files Max. file size: 50 MB. Print Name Date Day Month Year
