Newbury Street Practice
Self Help and Advice
Register for Online Access - Own Medical Record
To register for our online services you will need to complete this form and provide 2 forms of ID. You can either email this to firstname.lastname@example.org bring it into the practice. One of these items should include your photograph. We will then issue your registration details by email.
Last Updated: 20/07/2021
Register for Online Services
Date of Birth
Which online services would you like access to? (tick all that apply)
Order Repeat Prescriptions
Change personal details
Review and order repeat medications
View Medical Records (access from 01.03.17)
I give consent to be contacted by: (please select all that apply)
I wish to access this medical record online and I understand and agree with each statement (please tick all boxes).
I have read and understood the information leaflet provided.
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.
I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement.
If I see information on my record that is not about me, or is inaccurate, I will contact the practice as soon as possible.
I understand that the practice has the right to refuse access to my online record should access not be considered in my best interests.
I understand the practice has the right to remove access to services from anyone who does not use them responsibly.
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.
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