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ONLINE PROXY ACCESS UNDER 13 YEARS

Please complete this form if you are the parent, guardian or carer of a registered patient under the age of 13. 

Please ensure you have read the patient information leaflet to understand potential outcomes of full record access. Please note that Full Record Access is enabled following a review of your notes. We may need to restrict some information, if we do we will contact to discuss.

I wish to have access to the following online services (please tick all that apply):

Thanks for submitting the form.

 

Someone from our GP Practice will get in touch with you shortly. 

Child Details

Parent/Guardian Details

Terms and Conditions:
 

  • I have read and understood the information leaflet provided by the practice and agree that I will treat the patient information as confidential​

 

  • I will be responsible for the security of the information that I see or download

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  • If I choose to share the information with anyone else, this is at my own risk

 

  • I will contact the practice as soon as possible if I suspect that the account has been accessed by someone without my/our agreement

 

  • If I see information in the record that is not about the patient, or is inaccurate, I will contact the practice as soon as possible. I will treat any information which is not about the patient as being strictly confidential

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  • I understand that I may see information in their records that I may find upsetting

 

  • I consent to be contacted by the practice via text messaging service where appropriate

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