Proxy Access Application Form A

 
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Application for Online Access

Proxy Access Application Form A

This form is specifically for children living at a different address to the parent/carer requesting access, or where the parent/carer is not a registered patient at Wellspring Surgery

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Cared for Patient’s Details
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Parent / Carer Details

(Requesting proxy access to online services for the patient named above) We need these details to be able to trace your existing online user account

Title: *
Gender: *
Registered At: *
(if registered at another practice)
Relationship to child above: *

Proxy access will be given to:

  • Book/cancel appointments
  • Request repeat medication
  • View the core medical record (medication & allergies)
  • View immunisations information

If you are registered with us, access will be added to your existing Online Services account – you will be able to switch to child/cared for person’s account via Linked Users (in drop-down menu under your name). If you are registered elsewhere, we will email you the registration document you need in order to link your account to our practice patient. Please hand this form to reception – if your request is not actioned within 1 week then please contact us

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Providing NHS Services

Contact

Wellspring GP Surgery
Beam Street
Redfield
Bristol
BS5 9QY

Telephone: 0117 9557711

The Practice

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