Patient Access Form

 
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Patient Access allows you to request repeat prescriptions for any medications you take regularly and look at your medical record online.

Being able to see your record online might help you to manage your medical conditions. It also means that you can access it from anywhere in the world should you require medical treatment on holiday. 

The service is open 24/7/365 and can be accessed from your home PC, Tablet or Mobile phone.

To complete this form you must be able to upload a photo ID. 

Acceptable photo ID's are:

  • Current signed passport
  • Original birth certificate
  • EEA member state identity card
  • Current UK or EEA photcard driving licence
  • Full old-style driving licence
  • Photographic registration cards for self-employed individuals in the construction industry -CIS4

 

  • Benefit book or original notification letter from Benefits Agency
  • Firearms or shotgun certificate
  • Residence permit issued by the Home Office to EEA nationals on sight of own country passport
  • National identity card bearing a photograph of the applicant

We will not accept:

  • Mobile phone bills
  • Credit card statements

If you have a smart phone, you can download the Patient Access app by clicking on either link below, or by searching 'Patient Access' in your app store. 

All questions marked with a * are mandatory

Your Details
Please select the areas you would like access to: *
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

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