Requesting Online Proxy Access for GP Online Services – Adults 16 and over

1) The Proxy user/user applying for access must First:

Register via the NHS App or https://www.nhsapp.service.nhs.uk/login
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 for yourself to:

Order your repeat prescriptions
Make/cancel an appointment
Change your contact details
Review your medications and known allergies

2) Complete the Form Below to link the accounts

Proxy Access for GP Online Services - Adults 16 and over

Name
This field is for validation purposes and should be left unchanged.
Name
Title First Last
"Known As" or "Calling Name" if different
Date of Birth(Required)
Day
Month
Year
Address(Required)
Street Address Address Line 2 City Postcode
Additional access instructions if hard to find e.g. "What3words Address"
Make it easy for emergency services to locate your house to the nearest 3m if needed. Great for difficult to find houses. e.g. https://what3words.com/limitless.requires.fea
Primary Phone Number(Required)
Landline Telephone Number (optional)
Email
Consent for patients with capacity
I consent to give proxy access.
I give permission to Sonning Common Health Centre to give the below named individual/s Proxy Access to the online services as indicated below.
I reserve the right to reverse any decision I make in granting proxy access at any time.
I understand the risks of allowing someone else to have access to my health records.
Signature
Indicate here if the above named patient is unable to provide meaningful consent
I confirm I am applying on behalf of the above named patient
The above named patient is not able to give meaningful consent to share their medical record.
I am applying on the patients behalf.
I believe this is in their best interests, as it enables me to provide appropriate care and advocacy on their behalf.
Lasting Power of Attorney: Access Code
Please copy LPA access code below so we can confirm it's validity: https://www.gov.uk/manage-lasting-power-attorney/use-lasting-power-of-attorney
To be completed by the Proxy User applying for access
Name of Proxy user(Required)
First Last
Date of Birth of Proxy User(Required)
DD slash MM slash YYYY
Online Services Requested(Required)
- Booking my appointments
- Requesting my repeat prescriptions
- Updating my contact details
Please select all the services you wish to apply for:
Relationship to patient:(Required)
Consent(Required)
I agree that:
– I will be responsible for the security of the information that I see or download
– If I choose to share information with anyone else, this is at my own risk
– I will contact the practice as soon as possible if I suspect that this account has been accessed by someone without my agreement
– If I see information in the record that is not about the patient or inaccurate, I will contact the practice as soon as possible.
Signature
Security question: What is two plus three (2+3) [written as a numeral or number](Required)
You may only submit this form if you answer the question correctly, this is an anti-spam measure.

We aim to action all requests within 14 days, although often we manage this much sooner. If there are any issues with this request, we will contact you directly.

Booking an appointment

Tests & Results

Order Your Prescriptions

Get Support and Refer Yourself

Update Your Details

Sharing your information with someone who cares for you

Patient Participation Group

Online access to your medical record