Proxy Access to GP Online Services

To register for proxy access to our online services, you will need to complete this form.

We will then issue you with a username and  password.

Proxy Access to GP Online Services

Personal Details

The patient (to be completed by the child where age permits). This is the person whose records are being accessed.

Patient Consent

I have read and understood the following conditions: *

Online Services

The representative. This is the person seeking proxy access to the patient's online records, appointments or prescriptions.
I wish to have access to the following online services (Please select all that apply):

Representative Consent (Section 3):

The representative. This is the person seeking proxy access to the patient's online records, appointments or prescriptions.
I understand that my responsibility for safeguarding sensitive medical information and understand and agree with each of the following statements: *
Please tick next to the most relevant statement:

Proof may be required to indicate that parental rights have not been removed by the courts.

Personal Details (The Representative)

The representative. This is the person seeking proxy access to the patient's online records, appointments or prescriptions.
Any responses we send will go to this email address

Personal Details (The Representative)

The representative. This is the person seeking proxy access to the patient's online records, appointments or prescriptions.