Register for Online Services

To register for an online services account for appointment booking and prescription requests, you will need to complete and submit this form. We will then issue your username and password. If you have forgotten your password or are locked out please do not use this form but contact Reception.

Last Updated: 07/01/2022

Register for Online Services

Name *

Date of Birth *

Phone Number *

Email Address *

Address *

Postcode *

I would like access to my online services account to manage appointments and prescription requests. *

Yes No

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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the The Lodge Surgery website

Register for Online Services

Further Information

Connect With Us