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
• Review your medications and known allergies

Please note: Once you have completed this form you will need to present yourself at the practice with photographic proof of ID e.g. passport or driving licence.

Register for Online Services - Merton Medical

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Section

Address:

I wish to have access to the following online services:

Booking Appointments

Requesting repeat prescriptions

Accessing my core summary record

I wish to access my core summary record online and understand and agree with each statement:

I have read and understood the information leaflet provided by the practice

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

Terms and Conditions

I understand that it is my responsibility to keep my account secure by keeping my details confidential I understand that I can terminate my account at any time by contacting the surgery, or change my log in details by re-registering and that this form will be kept on my electronic records I understand that my registration will be revoked if I constantly miss or cancel appointments.

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I accept the terms and conditions stated above