Online Services Registration Form

Before completing this form please read section 1 & 2

Section 1: Important Information - Please read before filling in this form

Before you apply for online access to your record, there are some other things to consider. Although the chances of any of these things happening are very small, you will be asked that you have read and understood the following before you are given login details.

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 to you. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them. Please be assured anything that requires urgent attention will be actioned BEFORE it has been added to your patient record as information is added after review by a clinician.

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.

Section 2: Important Information - Please read before filling in this form

This form will take 10 working days from receipt to action. Once we have opened your record for you to access, your login details will be sent via email to the account you have stated on this form. If you have not supplied a secure email address then you can collect the login details from your local surgery at the Reception desk.

It will be your responsibility to keep your login details and password safe and secure. If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately.

If you can’t do this for some reason, we recommend that you contact the practice so that they can remove online access until you are able to reset your password.

Please note: If you print out any information from your record, it is also your responsibility to keep this secure. If you are at all worried about keeping printed copies safe, we recommend that you do not make copies at all. If we have any reason to believe that in giving you online access this may cause you physical and/ or mental harm the practice reserve the right to refuse you online access. Patient’s records will be checked upon receipt of this form in order to verify details and carry out safeguarding checks in line with legislation. If we are unable to offer you online access this will be discussed with you by one of our Operations Managers. Within your online records, beacon medical group members of staff are named in your records. By accepting your records you are bound by GDPR and therefore you should not share names of staff named in your records. In submitting this form you have read and understand section 1 & 2 and agree with each statement.

Online Services Registration Form

Have you read and understood section 1&2 and are happy to proceed?(Required)
Name(Required)
MM slash DD slash YYYY
Address(Required)
What is your preferred contact method?(Required)
Have you set up the NHS APP and need to prove who you are without photo ID?(Required)

If you have answered yes to this question, please follow the guidance notes below.

Once we have set you up for online services. You will need to access your account information tab. This will give you your account I.D and the organisation code. We will send your passphrase separately by your preferred contact method.

You will be given access to booking appointments, requesting repeat prescriptions, questionnaires and summary care records. If you wish to have full medical record access from 1st April 2019 please tick yes below. You will have to provide us with your photo ID.(Required)
Max. file size: 16 MB.