Application to View Medical Records Online

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All questions marked with a * are mandatory

Personal Details
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May be used to identify you

Please read all statements carefully and consider your answers before submitting the form

Your Declaration
I agree to my GP practice giving me access to my record online.: *
If I see information which does not relate to me, I will immediately log out and report the manner to the practice as soon as possible.: *
I agree that it is my responsibility to keep my username and password secure and not to share them with others. If I think my details have been shared inappropriately, I will reset them immediately. If you do not have access to the internet, contact the surgery to block your account.: *
I understand that I should not share my username or password and if anyone forces me, I have the right to say no. If someone does force me to show them my login details, I will tell the surgery as soon as possible.: *
I agree to take extra care when using a shared computer and make sure I log out when I’m finished looking at my record so that no one else can see my personal information.: *
I am responsible for keeping safe any information I may print from the record.: *
I understand that online access is granted at the discretion of the practice, taking into account my best interests. I will be informed of any decision to withdraw the service. Please note this does not affect your rights of Subject Access under GDPR.: *

Please read all statements carefully and consider your answers before submitting the form

Other considerations
If I notice any inaccuracies with my record, I will inform the practice manager as soon as possible of any errors or omissions.: *
I understand that I may see information on my record that I was unaware of/have forgotten about that could cause distress: *
I understand that, as before, I will be informed directly, by the practice, of any test results which require further action. However, I understand that I may see these results online before the practice has been able to contact me. This could be while the surgery is closed and there is no one available to discuss them with me: *

Privacy Consent


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