Register for Online Services

To register for our online services you will need to complete this form and then visit the practice, bringing  with you two forms of identification. One of these items should include your photograph.

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

Register for Online Services

Register for Online Services

If you are human, leave this field blank.

Are you registered as a patient at Paddington Green Health Centre? *

Yes

No

Please check the practice boundary and then register as a patient.

Patient Details

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Address, including postcode:

Phone Number:

Email Address: *

Any responses we send will go to this email address.

Terms and Conditions

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. I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement. If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible.

*

I wish to access my medical record online and understand and agree with each statement

Signature: *

Date: