Request for Online Access

Please find EMIS Access Information Sheet at reception for terms and conditions.


I would like to apply for an EMIS Access Account which gives me the ability to book routine GP appointments, cancel my appointments, request my repeat medication, and change my address/telephone number over the internet.

Your Details
(dd/mm/yyyy) - you must be 13 to qualify for this service
Contact Information
Please choose one of the following:

1. I will collect the letter containing my account details from reception in person and will bring an appropriate form of photo identification.

2. I would like to nominate a friend/relative/carer to collect my account details on my behalf. I understand the person collecting my details will have access to my confidential account information and I take full responsibility for any misuse of my

(if applicable)

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.