Advanced Online Access Application

Please complete this form if you would like access to your medical record online. Before completing this form, please read and understand the important information leaflet, which you can get from reception in surgery or online by visiting NHS App Online Services.

If you are human, leave this field blank.

If you are submitting the form on behalf of someone else, a proxy application form will be required (if not already completed). The application will not be accepted without a completed proxy form.

Please note - Online access cannot be given for anyone aged 11-16 years.

To complete a proxy form, please visit: Consent to Proxy Access to GP Online Services

Section

Address, including postcode:

I would like to access my online medical record including the following services:

Documents

Consultations

Problems summary

Allergies, medication and immunisations are already included

If you require basic access (booking appointments, requesting repeat medication, allergies, medication and immunisations), please complete a Basic Online Access Application instead.

By signing the form, I agree that: *

I have read and understood the important information provided by the practice on NHS App Online Services.

I agree to use the system responsibly in accordance with all instructions given to me by my GP practice.

I agree to be responsible for the security of the information that I see or download.

I understand that if I choose to share my information with anyone else, this is at my own risk.

I understand that I should contact the practice as soon as possibly if I suspect my account has been accessed without my permission or unlawfully.

I understand I will contact the practice should I see information that is not about me or is incorrect.

Signature: *

Date:

How to take a photo of yourself holding your ID

Take the photo in a room with enough light
Select the highest photo quality on the device you use to take the photo
Hold up the document next to your face, like in the example image
Make sure both your face and ID are clear on the photo - nothing on the ID can be covered or censored
If your photo is not of high enough quality (sufficiently sharp and not blurry), we will request a better copy.

To complete you registration, please upload a picture of you holding your proof of identity, this should include a photographic ID.

Maximum upload size: 67.11MB

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Section

How to take a photo of yourself holding your ID

Healthwatch Oxfordshire