Concord Medical Centre

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Online services registration form

Submit your online services registration form online. This allows you to order your repeat medication, see your medical record and more online.

Title*

Gender*

Ethnicity*

What is your date of birth?*
For example, 15 3 1984

Names

Contact Information

What is your address?*

Contact Preferences

We would like to contact you via SMS text messaging and via email. Please opt in or out of each service below.

We may wish to send SMS messages to our patients for reasons that include, but are not limited to, test results, appointment reminders and treatment information.

We may wish to send emails to our patients for reasons that include, but are not limited to, test results, appointment reminders, treatment information and your Patient Access registration details.

We would like to contact you via SMS text messaging. Please opt in or out of the service below.*

We would like to contact you via email. Please opt in or out of the service below.*

Online services registration

With online services standard access -

All patients have access to:

  • Booking appointments
  • Requesting repeat prescriptions
  • Demographics – change of contact details
  • Viewing my allergies
  • Viewing my medication

Additional Access under standard access:

  • Booking appointments

Would you like to register for online services?*

Detailed Coded Access -

Patients who select additional access have access to all actions listed under standard access, as well as:

  • Patient medical problems
  • Viewing consultations
  • Viewing medical documents
  • Viewing test results

Detailed Coded Access -

Patients who select additional access have access to all actions listed under standard access, as well as:

  • Patient medical problems
  • Viewing consultations
  • Viewing medical documents
  • Viewing test results

Detailed Coded Access - Please tick if required*

Detailed Coded Access - Please tick if required*

By registering for Online services

I wish to access my medical record online and understand and agree with each statement:

  • I will be responsible for the security of the information that I see or download.
  • If I choose to share my information with anyone else, this is my own risk.
  • I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement.
  • If I see information in the record that is not about me, or is inaccurate, I will contact the practice as soon as possible. I will treat any information not about me as confidential.
  • I have read and understood the information leaflet provided by the practice.

By registering for online services

I wish to access my medical record online and understand and agree with each statement:

  • I will be responsible for the security of the information that I see or download.
  • If I choose to share my information with anyone else, this is my own risk.
  • I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement.
  • If I see information in the record that is not about me, or is inaccurate, I will contact the practice as soon as possible. I will treat any information not about me as confidential.
  • I have read and understood the information leaflet provided by the practice.

How would like to receive your login details for online services?*

How would like to receive your login details for online services?*

Please confirm your email address?*

Please also opt IN to receive emails if you have said you would like to receive your online services details via email.

Please confirm your email address?*

Please also opt IN to receive emails if you have said you would like to receive your online services details via email.

Please supply proof of address.

No files selected!

Please supply proof of identity.

No files selected!

We require proof of identity such a photo of your passport or driving licence and proof of address such as a photo of a utility bill or bank statement.