Online Access Support - Wistaria and Milford Surgeries

Online Access

Still Need Help With The NHS App? Please Complete The Form Below, So Our IT Team Can Assist.

PLEASE NOTE THIS FORM IS NOT INTENDED FOR CLINICAL QUERIES.

NHS App Setup

Please Confirm You Are A Wistaria Or Milford Patient *

I confirm that I am a patient of Wistaria and Milford Surgeries

Select An Option:

Request Support With Online Access

Request Linkage Key

Request Proxy Access

Full Name *

Date of Birth *

Home Number *

Mobile Number *

Email Address *

First line of address *

Please Provide The Information For The Support You Require

Name Of The Person Requesting Proxy

First Name

Last Name

DOB:

Name Of The Person Wanting To Share Their Records With The Person Requesting Proxy

First Name

Last Name

DOB:

Age

Download Consent To share Form 13 & Above Only