Request Access to NHS App and Medical records

NHS App

Did you know that patients can access our online services such as booking appointments, requesting medication or seeing medical records directly via the NHS App, without the need to request access from The Exchange Surgery?

The NHS App is a simple and secure way to access a range of NHS services on your smartphone or tablet. You can also access NHS App services from the browser on your desktop or laptop computer. To find out more go to www.nhs.uk/apps-library/nhs-app

After you download the app, you will need to set up an NHS login and prove who you are as follows:

1. take a photo of your I.D.
2. record your face using your device
3. enter your NHS number if you know it

If your device supports fingerprint detection or facial recognition, you can use it to log in to the NHS App each time, instead of using a password and security code.

If you have any issues using or downloading the app, please check the NHS App help and support page.

If you are still experiencing issues, please complete and submit this form to us.

Full Name

First Last

Date of Birth

Sex

Male

Female

Other

Phone Number Optional

Further Details

Current Home Address

Street Address Address Line 2 City Postcode

Please select one of the options below

I am a patient at The Exchange Surgery and I would like to book appointments, request repeat prescriptions and see my basic GP health record i.e. allergies, medicines and confirmation of my Covid-19 vaccination(s)

I am a parent or guardian of a patient aged under 11 and would like proxy access to their record.

I am a parent or guardian of a patient aged 11 to 13 and would like proxy access to their record.

I am a parent or guardian of a patient aged 13 to 15 and would like proxy access to their record.

If you would like proxy access to the records of an adult family member or person you care for who is registered at The Exchange Surgery, we will require the patient you represent and/or you to complete and sign a proxy consent form below instead of this form:

Consent to Proxy Access to GP Online Services form

Terms and Conditions

By completing this application form, I agree to the following conditions:

I have read and understood the Online Access for Patients – Important Information. I accept that it is my responsibility to maintain the security of any information that I see, download or choose to share with others.
I understand that I can terminate my account at any time by contacting the surgery, or change my log in details by re-registering and that this form will be kept on my electronic records.
I will contact the practice, as soon as possible, if I suspect that any of my accounts have been accessed by someone without my agreement or if I see information in my record that is not about me or is inaccurate.
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.
The practice may withdraw my access to any online services, if it considers that they are being used inappropriately.

Signature

(PRINT your full name)

I accept the terms and conditions stated above.

To complete your online registration, we request that you upload a photo of yourself holding a proof of your ID, with both your face and the ID clearly visible in the photo. The ID must be either a passport or a driving licence which is currently in date. If you are requesting proxy access, we require proof of ID for both yourself and the patient. Please attach your files here:

Accepted file types: jpg, png, gif, Max. file size: 10 MB.