Register for Online Services - Leacroft Medical Practice

To register for online services you will need to complete this form and attach a picture of your photo identification.

Please be advised that you will need to be a registered patient at this surgery to make use of our online services.

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

Application for Online Access to GP Services

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:

Keeping your online health and social care records safe and secure

Are you completing this form on behalf of:

Yourself Optional

Someone else (e.g. a child or dependent) Optional

About you

Name

First Last

Date of Birth

Day

Month

Year

Sex:

Male

Female

Other

Address

Street Address Address Line 2 City Post Code

Phone Number

Enter Email Confirm Email

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

If you consent to be contacted by either of the following please tick:

Mobile

I do not consent

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 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

Print Name

Date

Day

Month

Year

Please send your ID to sxicb-wsx.leacroft@nhs.net.

I have sent my ID via email

In the subject field, please enter ‘Register for Online Services – ID Upload – YOUR NAME‘.