Patient Service Registration Form for repeat prescriptions

Patients aged 16 and over must have their own individual email address to apply for a Patient Services account unless exceptional circumstances apply (e.g. patient doesn’t have capacity to order own medication). The provisions are in place in order to comply with GDPR regulations.

For parents applying for a Patient Services account for a child aged 12-15, if the child is deemed to have capacity (they are competently able to make their own decisions) then they will be required to have an individual email address. Younger children, and those not deemed to have capacity can be linked to a parent/carer email.

To register for this online service please complete this form and submit. On receipt of this completed form, we will email the address given to confirm we have the correct email address. On receipt of a reply, we will generate the account set-up letter to enable you to set up your Patient Services Online Account. An email from either NoReply@MyVisionOnline or [email protected] (check inbox and junk mail) will be sent with the letter attached. There may also be an email from the practice directly as a failsafe with the letter attached.

Patient Services

Name

First Last

Date of Birth

Address

Street Address Address Line 2 City Post Code

Enter Email Confirm Email

This email must be unique to each patient – please do not share email addresses with others in the household

Mobile Phone Optional

If you wish to receive text messages for appointment reminders and messages from GPs regarding your healthcare via text, please included your mobile number here and we will update it on our system. If you do not wish to have this service, please leave blank. There is no cost for this service.