Issues registering for Patient Services?

**This form is for people having problems registering with Patient Services, our online booking system. DO NOT use the form to send us details of medical issues and to request an appointment. If you do, the form WILL NOT be responded to.**

If you’re having problems registering for Patient Services, please fill in the form below and someone from the Practice will be in touch to help. Please be aware that this may not be on the same day you fill the form in – we’ll get in touch with you as soon as possible though.

Patient Services sign up issues

First name *

Last name *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Postcode

Email *

Enter Email

Confirm Email *

Confirm Email

Best phone number to contact you on *

Please contact me by:

Phone

Either

What issues are you having with Patient Services?

0 of 75 max words

Please upload a photo of any error messages if you think this would be useful

Maximum file size: 5MB

It’s very useful for the Practice if you allow us to use your mobile number for text messaging. It saves the Practice (and the NHS) time and money.

If you allow us to use your mobile number, we’ll contact you by text with appointment reminders. We may also contact you about other important matters including inviting you for health reviews, to let you know that test results have been returned to us, or other important general Practice information. We won’t contact you about generic health promotion information that isn’t individual to you.

Please be aware that if you don’t consent to us contacting you by text (SMS) this will opt you out of ALL text messages from the Practice and you won’t receive appointment reminders, notification of test results and other important information about your health by text.

Do you consent to the practice contacting you by text (SMS)?

Yes – I want to get appointment reminders by text and other important information as listed above

No – I don’t want to get text appointment reminders and other important information as listed above

Not applicable (I don’t have a mobile number)

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.

I consent to the practice collecting and storing my data from this form.

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