Register Your Interest for Online Services

Name *

Date of Birth *

Phone Number *

Email Address *

Address *

Postcode *

Please advise the best time/s to contact you to set up your online access, bearing in mind this needs to be a time when you will have your ID available as we may need to video call you to confirm your identity *

I understand that It is my responsibility to keep my account secure by keeping my details confidential I understand that I can terminate my account at any time by contacting the surgery, or change my log in details by re-registering and that this form will be kept on my electronic records I understand that my registration will be revoked if I constantly miss or cancel appointments. *

I consent to the practice collecting and storing my data from this form.

Cookies on the The Waterloo Practice website

Register Your Interest for Online Services

Further Information