Proxy Access

To register for online services on behalf of some else. 

Last Updated: 03/02/2023

Online Access Patient Information

Section 1

Section 2

To be completed by the patient

Section 3

To be completed by the representatives

Section 4

The Patient - (this is the person whose records are being accessed.)

The representatives

These are the people seeking proxy access to the patients online records, appointments or repeat presctiption

Privacy Policy

This form collects your name. date of birth, email, other personal information and medical details.  This is to confirm you are registered with the practice, to allow the practice tream to contact you and also to update your medical records held by the practice and our partners in the NHS.  Please read our Privacy Policy to discover how we protect and manage your submitted data. 

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.