Register for online services Use this service to register to use GP online services. You can use this service if you: are registered at the surgery X/Twitter OptionalThis field is for validation purposes and should be left unchanged.Who are you completing this form for? Yourself Someone else What is your name? First Last What is your date of birth? DD slash MM slash YYYY What is your sex? Male Female Other As recorded on your medical record What is your postcode?What is your phone number?What is your email address? Anyone else with access to your email account may see responses sent to you Address OptionalTerms and Conditions I accept the terms and conditions stated aboveI 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.