My Health Online

Last Updated: 14/11/2022

Request for Access to My Health Online

My Health Online offers you the convenience to book appointments online (when available). Depending on your practice you may be able to order repeat prescriptions online or change your contact details. If you wish to register to use My Health Online please complete the following form.

Please note that separate forms are required for:

Under 16s

Those acting on behalf of another

These can be downloaded via our website, or are available for collection from Reception/Dispensary.

Declaration of consent

SMS CONSENT *

SMS TEXT MESSAGING IS A SERVICE OFFERED ACROSS WALES WHERE ALL GP PRACTICES HAVE THE ABILITY TO SEND TEXT REMINDERS FOR SMS TEXT MESSAGING AND INFORMATION ABOUT SERVICES TO PATIENTS. IF OFFERED BY MY PRACTICE, I AM HAPPY TO BE CONTACTED VIA SMS TEXT MESSAGING

I DECLINE THE SMS TEXT MESSAGING SERVICE

SECTION A - TO BE COMPLETED BY ALL

The information on this form is used to verify your identity. If you can not provide the requested information, or it does not correlate with your existing records, you may be required to present with another form of identification prior to us granting you access.

Full Name of Patient *

Date of Birth *

Full Address *

Postcode *

Telephone number 1 *

Telephone number 2 (if applicable)

Email Address (you will receive your registration details to the email provided) *

Please confirm email *

NHS Number (This comprises of 10 numbers) *

Patient's Preferred Language *

Welsh

English

Declaration *

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA

PRACTICE CHECKLIST - TO BE COMPLETED BY PRACTICE STAFF PRIOR TO GRANTING ACCESS

1 - Patient's identity documents verified and checked (please note what documents were checked)

2. Details of documents checked and name of individual authenticating (if required)

3. Patient's name and date of birth checked on this form validated against clinical system

4. Patient's preferred language and contact details updated on the clinical system (if required)

5. Registration process and next steps explained. Registration letter given to patient

6. The 'Safe and Secure Leaflet' and 'What you need to know bout MHOL records Leaflet have been provided to the patient.

These are available via the My Health Online website for patients to access.

7. Nominated individual advised to register their online account within the next 48 hours

8. There is a process in place for access to be revoked if requested to do so

We aim to process the request within 1 working day of receiving your request. Once completed, you will receive an email containing the details required to activate your online account.

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