Consent to Proxy Access to GP Online Services

Last Updated: 03/03/2021

Consent to Proxy Access

If the patient does not have capacity to consent to grant proxy access and proxy access is considered by the practice GP to be in the patient's best interest, this section may be omitted.

The Patient

This is the person whose records are being accessed


Please give details of the representative(s) wishing to have online access to the services requested in the Permission Section.


The Representatives

These are the people seeking access to the patient's online records, appointments or repeat prescriptions.

Electronic Submission

This form cannot be processed without identification being provided for each person named above.