Skip to content

Patient access agreement

Personal information?

Identification Verification (please tick the statement that applies)

 
 

Standard Access

 

Additional Options with enhanced access (please tick all the statements that applies)

 
 
 
 

I further understand and agree with each statement below

 
 
 
 
 
 
 

About This Form

Fields marked with a red asterisk are compulsory.*

You will be contacted by email at the earliest opportunity (so it is essential we have an email address which is securely yours) which should not normally be longer than two weeks.

Documentary Proof

We need to verify your ID before any access is granted and you should do this by downloading the NHS App onto a smartphone or tablet.  If you do not have one of these devices, the surgery will contact you to verify your ID.

Confidentiality

There may be an instance when accessing your medical record online, that you may read some information that could be unexpected or upsetting. If this happens you should contact the practice when they are next open to discuss the issue with them.

We use cookies to improve your experience and deliver personalised content. By using our site, you agree to our Cookies policy.

Read cookie policy