After you have completed this form you will need to provide the practice with two forms of ID (one photographic and one recent proof of address e.g. A utility bill within the past three months). Your user details will be sent to you via text (or email if preferred) 10 working days after the application is submitted. In some circumstances the practice may want to discuss your application with you in more detail, you will be informed of this by a letter.

Please Note:

• It will be your responsibility to keep your login details and password safe and secure.  If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately.  Access can also be gained on some phones using fingerprints or Face ID – please consider this.
• If you have concerns about this, we recommend that you contact the practice so that they can remove online access until you are able to reset your password.
• If you print out any information from your record, it is also your responsibility to keep this secure.  If you are at all worried about keeping printed copied safe, we recommend that you do not make copies at all.
• The practice may not be able to offer online access due to several reasons such as concerns that it could cause harm to physical or mental health or where there is reference to third partis.  The practice has the right to remove online access to services for anyone they feel it could harm or be put at risk. 

Key Considerations

Forgotten history

There may be something you have forgotten about in your record that you might find upsetting.

Abnormal results or bad news

If your GP has given you access to test results or letters, you may see something that you find upsetting to you.  This may occur before you have spoken to your doctor or while the surgery is closed, and you cannot contact them.

Choosing to share your information with someone

It is up to you whether you share your information with others – perhaps family members or carers.  It is your choice, but also your responsibility to keep the information safe and secure.

Coercion

If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time.

Misunderstood information

Your medical record is designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information within your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification, please contact the surgery for a clearer explanation.

Information about someone else

If you spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible.

---

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

---