Online Access to GP Services Form - Fakenham Medical Practice

Register for Online Services

Once your application for online access services has been processed, we will contact you with your account login details.

We will need a photo ID to confirm your identity prior to issue.

Before you apply for online access to your medical record, there are some other things to consider.

Although the chances of any of these things happening are very small, you are asked that you have read and understood the following before you are given login details.

Things to consider

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. 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’s up to you whether or not you share your information with others – perhaps family members or carers. It’s 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.

More information

For more information about keeping your healthcare records safe and secure, we recommend that you read Protecting your GP Online Records and this helpful leaflet produced by the NHS in conjunction with the British Computer Society:

Are you completing this form on behalf of:

Yourself

Someone else (proxy access) (e.g, a child or dependent)

Patients Details

Name

First Name(s) as appears on your passport. Last Name(s) as appears on your passport.

Your Date of Birth

Day

Month

Year

Your date of birth is required to verify your identity.

Sex

Male

Female

Other

As on your medical record.

Address

Street Address Address Line 2 City Postcode

Your Email

This email address can be used to contact you about your request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Your Phone Number:

The practice may use this number to contact you about your request.

Your Details (the person requesting proxy access)

Full Name

First Last

Date of Birth

Day

Month

Year

Address

Street Address Address Line 2 City Postcode

Contact Number

Relationship to Patient

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

Booking appointments

Requesting repeat prescriptions

Sending secure messaging

Access to detailed medical record

Proxy Access to records for family members who I care for with separate login details

I understand that my email address and/or mobile number may be used by the practice to contact you to provide health and care services. For example:-

appointment reminders

health campaign messages

messages relating to your own health and care e.g. test results

surveys about our services

Terms and Conditions

I wish to access my online services and understand and agree with each statement (tick)

I have read and understood the information provided by the practice

I will be 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

If I suspect that my account has been accessed by someone without my agreement, I will contact the practice as soon as possible

If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible

If I think that I may come under pressure to give access to someone else unwillingly I will contact the practice as soon as possible

If I see something in my records that I am unsure of and have not yet been contacted by the surgery, I will wait until usual opening times and not contact the out of hours or emergency services

To complete your registration please upload proof of identity, this should include Photographic ID (i.e., Driving licence or Passport, not a photograph) and proof of address.

Drop files here or

Max. file size: 50 MB.