You will need to visit the practice in person with your proxy user.

You will both need to bring a valid form of identification, for example photo ID, bank statement or your passport if you would like to register a proxy user. A proxy user MUST have a registered online account.

If you have multiple people you would like as proxy. You will also need the form ‘Section 5.2 – Additional Proxy user’ from reception to bring back with this form.

Please note: that it will take 21 days to process an application for online access to medical records. Access for booking appointments and ordering repeat prescriptions will be enabled as soon as possible.

• If you are the patient authorising proxy access to a person you trust please fill in Section 1,2 & 3
• If you are the parent/guardian of a child under the age of 12 wanting to be a proxy user on their behalf please fill in Section 1,2 & 3.  You do not need to put a signature in the signature boxes either leave blank or put N/A. You need to put your child’s name as patient name. You will need to bring in your child’s birth certificate for identification.
• If you have/are a child over the age of 12 who would like to re-instate consent for medical records to be shared please fill in Section 1, 2 & 3
• If you are acting on behalf of a patient who is without capacity please fill in Section 3 & 4 only. This will then be sent to the patient’s GP to authorise proxy rights at their

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The person you are granting proxy user status to must fill out Section 5 and 5.1 after you have filled out the appropriate sections above, and bring it with you to the practice.