Online Services Registration

This form is for patients already registered with the practice. If you wish to register with the practice please go to the New Patient Registration Form

If you are registered with the Dedridge Medical Group, please complete this form to request access to our online services such as appointment booking/cancelling and prescription requests.

First name

Surname

Date of birth

Address

Postcode

Preferred Email address

Telephone number

Preferred Mobile number

I wish to have access to the following online services (* Booking appointments and online summary currently unavailable)

Requesting repeat prescriptions

I wish to use Online Services. Please read each statement carefully and tick before completing the form

I have understood the information provided by the practice

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

If I choose to share my information with anyone else, this is at my own risk

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

If I see information in my record that is not about me or is inaccurate, I will 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 Dedridge Medical Group • Nigel Rise, Dedridge, Livingston, EH54 6QQ.

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.