Register for online services

Online access registration

Please fill out this form to register for online access

"*" indicates required fields

I would like to apply for the following online services:*

Requesting repeat prescriptions

Booking appointments

Viewing summary information from medical records

In signing this registration form, I agree that

(please tick below)

I have understood the information leaflet provided by the Practice

I consent to receiving SMS from the Practice

I consent to receiving Emails from the Practice

I will be required to provide photographic identification before I can access online services (e.g. driving licence, passport, identity card, etc)

I will be provided with a user code that will be unique to me and that it is my responsibility to keep my username and passwords secure. If I believe these to have been shared inappropriately, I will reset this using instructions via Systmonline.tpp-uk.com

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 log out immediately and contact the practice as soon as possible

It is my responsibility to notify the Practice of any change in my contact details

Online services are provided at the discretion of the practice and may be withdrawn by the practice at any time. I understand that the practice reserves the right to withdraw my access to online services if I misuse this service

If you would like access to your detailed coded records please request this via the SystmOne site when you have logged on

Full name*

Date of birth

Address line 1*

Address line 2

Postcode*

Home phone number

Mobile number

The information you give us must match the information we hold for you in our system

Image upload*

Max. file size: 2 MB.

Please upload a picture of yourself holding your photo ID

If the patient is under the age of 11, online access may be applied for by the parent/guardian (Proxy Access) all patients attaining the age of 11 will be required to apply for access for online services to be continued.

Name of parent / guardian

Tick to sign this form

Date*

This field is for validation purposes and should be left unchanged.

Online access registration

Please fill out this form to register for online access

"*" indicates required fields

I would like to apply for the following online services:*

Requesting repeat prescriptions

Booking appointments

Viewing summary information from medical records

In signing this registration form, I agree that

(please tick below)

I have understood the information leaflet provided by the Practice

I consent to receiving SMS from the Practice

I consent to receiving Emails from the Practice

I will be required to provide photographic identification before I can access online services (e.g. driving licence, passport, identity card, etc)

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 log out immediately and contact the practice as soon as possible

It is my responsibility to notify the Practice of any change in my contact details

If you would like access to your detailed coded records please request this via the SystmOne site when you have logged on

Full name*

Date of birth

Address line 1*

Address line 2

Postcode*

Home phone number

Mobile number

The information you give us must match the information we hold for you in our system

Image upload*

Max. file size: 2 MB.

Please upload a picture of yourself holding your photo ID

Name of parent / guardian

Tick to sign this form

Date*

This field is for validation purposes and should be left unchanged.

Pages

Friends and Family Test
Foundry Care Team
Prescriptions

Information

Privacy Notice
Zero Tolerance Practice Policy
Provision of Direct Care
GP Earnings
National screening programmes
Legal requirement to share data
Staff Login

Associations

Contact

01273 480888
sxicb-esx.foundryhealthcarelewes@nhs.net

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