Trinity Medical Centre

"Putting Pride

into

Practice"

Online Access Application Form

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 - Data Sharing

We are constantly keeping our records up to date so would like to ask a few questions about your health records.

Patients have the option to share their health records and information with other services that are providing them care. You also have the option to allow services to share this information with us. All the information recorded by other health care professionals forms an important part of your record and it is useful for all healthcare professionals involved in your care to be able to see everything so that they can provide the most appropriate care.

This is known as Sharing In and Sharing Out. Consent must be given at each organisation that treats you and you can change your preference at any time.

More information can be found on our Data Sharing Page

Sharing Out
YES I would like to share my information with other health professionals involved in my care.NO do not share any of my information with other health professionals.

Sharing In
YES I would like my GP to be able to see information recorded by other health professionals involved in my care.NO I do not want my GP to see any information recorded by other health professionals.

Section 4 - Communication

You will receive a verification email/SMS asking you to confirm your date of birth

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 2018 for training;

  • 21st Feb
  • 21st Mar
  • 25th Apr
  • 16th May
  • 20th Jun

  • 18th Jul

  • 19th Sep

  • 17th Oct

  • 14th Nov

Patient
Participation
Group

Our PRG group meet on a regular basis to discuss practice matters. The next meeting is;

Wednesday 5th September 2018, 2pm

Click Here to Join