Register for Enhanced Online Access

Please note, if you wish to register for enhanced online services, please complete the form below. By completing this form you acknowledge that you may see information, e.g. Test Results, before a clinician / the surgery has had a chance to contact you.

First Name *

Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Address *

Address

Town/City

County

Postcode

Country

List any specific requests

Signature

Clear

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 team 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.

I consent to the practice collecting and storing my data from this form. I also acknowledge that I may see test results before the surgery has had a chance to contact me.

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