Basic Online Access Application

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.

Basic Online Access Application

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

I wish to have access to the following online services:
Allergies and medications are already included

If you already have basic access and only require advanced online access, please complete an Advanced Online Access Application instead.

By signing the form, I agree that: *

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