Online NHS App request form

Use this form to request only access to your medical records or to manage your repeat prescriptions.

Last Updated: 16/02/2022

Your details

First Name *

Surname *

Date of Birth *

Your contact details

Please make sure you fill in at least one

e-mail address *

Telephone number

Mobile number

Which services do you want access to online

Please tick those that apply

Services required

Requesting repeat prescriptions

Accessing medical records

Test results

Documents

Immunisation

Are you requesting access for yourself, or someone else? *

I'd like access to my own records

I'm requesting access to my child's records

I'm requesting access to the records of someone I care for.

Consent

It's important that your information is kept private and secure

I understand and agree with each statement (please tick)

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

If I suspect that my account has been accessed by someone without my agreement, I will contact the practice as soon as possible

If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible

If I think that I may come under pressure to give access to someone else unwillingly I will contact the practice as soon as possible.

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