Register for Online Services

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

We will then issue you a username and password.

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

Order your repeat prescriptions
Make an appointment
Cancel an appointment
Change your contact details
Review your medications and known allergies

If you are human, leave this field blank.

Section

Address, including postcode:

Which surgery is normally attended?

East Harling Surgery

Kenninghall Surgery

Both

I wish to have access to the following online services (please tick all that apply):

Booking appointments

Requesting repeat prescriptions

Accessing my medical record

The records we hold usually go back to your date of birth; from which year would you like access from? *

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 login 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 wish to have online access and understand and agree with each statement:

I will be completely responsible for the security of the information that I see or download.
If I choose to share my information with anyone else, this is at my own risk.
I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement.
If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible.
I confirm I will provide ID if asked.

I accept the terms and conditions stated above

Signature: *

Date:

Tell us whether you accept cookies

Register for Online Services