Register for Online Services - surgery form

To register for our online services you will need to complete this form and email your ID documents to sidney.laurels@nhs.net or visit the practice, bringing with you two forms of identification. One of these items should include your photograph. We will then issue you a username and password.

Last Updated: 13/05/2022

Register for Online Services

Name *

Surname *

Date of Birth *

Phone Number *

Email Address *

Address *

Postcode *

Which online services would you like access to? (tick all that apply) *

Requesting Repeat Prescriptions

Booking Appointments

Accessing My Summary Care Record

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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Register for Online Services - surgery form

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