Register for Online Services

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

Please check your emails for instructions on how to send your photo ID and proof of current address. You cannot be registered for online access unless you do so.

Your registration form will expire after 30 days, after which you will need to complete the form again should you wish to register for Patient Online Services.

Once you are registered you will be able to use the service to:

• Order your repeat prescriptions
• Make an appointment
• Cancel an appointment
• View your medical record

Register for Online Services - Kintbury and Woolton

Register for Online Services - Kintbury and Woolton

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Any responses we send will go to this email address.

Address, including postcode:

Terms and Conditions

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 accept the terms and conditions stated above