Patient online registration request

Requesting Online Access to Your Health Information

We’re committed to making your healthcare experience as convenient and transparent as possible. Patients can now request online access to their medical records and services through our secure digital platform.

How to Request Access:

Complete the Online Access Request Form.
Complete the form below to request online access to your health information.
Provide Identification
The practice will then contact you either with your account details or to advise if verification of your identity is required (e.g. you presenting the practice with photographic id).”
Wait for Confirmation
Once your request is processed, this can take up to 28 days, you’ll receive an email with instructions to activate your account.
Start Using Online Services
After activation, you’ll be able to book appointments, view test results, order repeat prescriptions, and more.

Your Privacy Matters

All data is protected under NHS guidelines and GDPR regulations. We take your privacy seriously and ensure your information is secure.

If you have any questions or need assistance, please contact our reception team or email us at M92015a.wolverhampton@nhs.net

Information Leaflet

Please download and read this leaflet before completing the form below (PDF, 181KB)

Patient online registration request

Surname

First Name/s

Date of Birth

Address

Postcode

Email Address

Home Telephone Number

Mobile Number

I wish to have access to the following online services (select all that apply):

Booking appointments

Requesting repeat prescriptions

Accessing my medical record

Application for online access to my medical record

I wish to access my medical record online and understand and agree with each statement (please tick each item)

I have read and understand the information leaflet that can be downloaded at the start of this page

I will be responsible for the security of the information I see or download

I will contact the practice as soon as possible if I suspect that my account has been accessed by someone else without my agreement

If I see information in my record that is not about me, or is inaccurate I will log out immediately and contact the practice as soon as possible

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to I H Medical - Improving Health • Bilston Health Centre, Prouds Lane, Bilston, West Midlands, WV14 6PW.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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