Almshouse Surgery 
& Sandal Castle
Medical Centre

"Putting patients interests at the heart of what we do"

Application for Online Access to Services

Section 1 - Your Details

Your First Name

Your Surname

Your Date of Birth

Your Address

Your Post Code

Your Email

Your Phone Number

Please Select

Section 2 - Terms of Agreement

I wish to access my online services and understand and agree with each statement below;
I have read and understood the information leaflet provided by the practice about online access.

I will be responsible for the security of my login details as well as any of the information that I see or download.

If I choose to share my information with any else, this is at my own risk.

I understand that abusing the online services offered will result in the online service being removed.

I will contact the practice as soon as possible if I suspect that my account has been accessed without my agreement.

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

I consent to the practice using my email address and phone number for reminders and communication from the practice

Section 3 - Communication

Please confirm how you would like to receive your login details;

You will receive a verification email/SMS asking you to confirm your date of birth. The practice will then contact you to verify your identity.

If you require access to another patients account please visit the practice for the appropriate additional forms

By ticking the box below you are digitally signing this form.

You must tick all the above terms of agreement before you can SEND this application

TRAINING DAYS

We will be closed from 12pm on the following WEDNESDAYS in 2017 for training;

  • 18th Jan
  • 22nd Feb
  • 15th Mar
  • 26th Apr
  • 17th May
  • 21st Jun
  • 19th Jul
  • 20th Sep
  • 18th Oct
  • 15th Nov