Request Online Access to Records – Consent

You can now view your GP medical record online to look at test results, dates of consultations and your medical history, including current and past medication.

If you would like to have secure online access to your records, we need to make sure that you understand what this involves and that you are happy for us to use the information about you to set up and operate the service.

The following form will take you through the things you need to think about. By completing the form you will be giving us your permission to go ahead with setting up the service for you.

If you decide not to join, or wish to withdraw, it will not affect your treatment in any way.

You will also be required to provide 2 documents as proof of identity with your application, one of which must contain a photograph. Acceptable documents include passports, photo driving licences and bank statements. If none of the above are available, household bills may be accepted at the discretion of the Practice Management.

Access is granted at the discretion of the practice. Your request for access may take up to 15 working days to process and longer during peak periods. You will be informed if access cannot be granted.

This website is not monitored out of surgery hours so patients will not receive any response until service resumes. Please redirect requests to NHS 111 or your local pharmacy out of hours.

Patient Consent for Detailed Coded Record Access

Patient Consent for Detailed Coded Record Access

Patient Details

Please use date format DD/MM/YYYY
If this email address is shared with others please consider whether you agree that it can be used to send you confidential information about your account, services used and health care.

Declaration

Please select the appropriate option below.
I agree to my GP practice giving me access to my record online. *
I have been provided with an information leaflet about access to GP medical records which I have read and understood. *
I agree to use the system in a responsible manor in accordance with all instructions given to me, by the practice. If not, access may be withdrawn. *
If I see information which does not relate to me, I will immediately log out and report the matter to the practice as soon as possible. *
I agree that it is my responsibility to keep my username and password secure. If I think these have been shared inappropriately I will reset them using the instructions supplied. I am also responsible for keeping safe any information that I print from the record. *
I agree that my details below may be used to contact me about how useful I find the service and whether it could be improved. *
I understand that online access is granted at the discretion of the practice, taking into account my best interests. I will be informed of any decision to withdraw this service. *

Other Considerations

The practice makes every effort to record information as accurately as possible, however there may be information that you do not feel is correct.
If I notice any inaccuracies with my record, I will inform the practice as soon as possible of any errors or omissions. *
I understand that I may see information on my record that I was unaware of/have forgotten about that could cause distress. *
I understand that as before, I will be informed directly, by the practice, of any test results which require further action. However I understand that I may see these results online before the practice has been able to contact me. This could be while the surgery is closed and there is no one available to discuss them with me. *