Patient Online – Proxy Access

Please use this form to request access to your child/another patient’s record. Access is granted at the discretion of the GP.

Access will not normally be granted if your child is aged over 10 years and 6 months. GP assessment of your child’s competency to consent may be required.

Information about Proof of identity documentation can be found here

Patient Online – Proxy Access

Parent/Carer Information

Address (if different to patient)
Address (if different to patient)
Town
County
Postcode
Country
Consent

Patient Details

Please complete with details of the patient record you would like to access
Patient’s Address
Patient's Address
Town
County
Postcode
Country
Relationship to Patient

Identification

Please upload:
1 x Photo ID (Passport/Driving License)
1 x Address ID (bank statement, telephone bill, council tax statement)
1 x Child’s birth certificate
Photo ID
Maximum upload size: 8.39MB
Address ID
Maximum upload size: 8.39MB
Child’s Birth Certificate
Maximum upload size: 8.39MB