Register for online services - Woodbank Surgery

Use this form to let us know you would like to be registered for online services, via this website.

Fields marked with a red asterisk are compulsory.

Note by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your information.

Full name*
Postcode*
Home address*
Date of birth*
Date Format: DD slash MM slash YYYY
Home telephone*
Mobile telephone*
Email address*
Enter Email Confirm Email
Consent*
I agree to the privacy policy.
Please note that no medical information or questions will be responded to. The data you supply on this form will be stored on our website, which is hosted by a third party, until it has been processed by the practice. The data will be used lawfully, in accordance with the Data Protection Act 2018, which gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly. The practice privacy policy can be viewed on this website.