Make an online account for a child or someone you care for

 

Setting up an account as a parent/guardian

It is possible for parents to set up an account for a child that they will control as a proxy on behalf of the child. It is also possible for main carers and those with power of attorney over adults to set up accounts. The following needs to be done first:

  1. for all children, we require ID upload. This can be a birth certificate or in the case of a newborn, the birth discharge summary
  2. for children over the age of 12, the child's consent would also be required (this can be done online below)
  3. for adults who do not have a written power of attorney in place, their written permission would be required (this can also be done below)
  4. the guardian wanting to act as a proxy would need to be set up on Patient Access already, if you're not already setup, click here and you can start the process for yourself
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Patient's Details
Relationship to patient
 
Please upload the Last ing Power of Attorney in the upload section below

 

Please either upload a signed statement from the patient that they are happy for you to be a Proxy for them for online services or have them sign the form below
Identification Upload

Patient Identification 

Please upload one form of ID for the patient as per the list below

We will not store these documents and we will securely delete / destroy them after our initial verification.

Acceptable Identification: Photo Driving License, Passport, Residency card (for children a birth certificate is acceptable).

Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Signature of Parent/Guardian
Child signature
As your child is over 12 years old, we need their consent for a proxy online account to be created
Signature of patient

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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