HILLHEAD FAMILY PRACTICE 
www.hillheadfamilypractice.co.uk 

Would you like to request repeat prescriptions and book appointments without having to telephone or call into the surgery?    Did you know that you can use the practice web site to do this?

The web site also gives you information about the practice, including opening times, clinics and any changes to services.

You can access our web site at any time, but if you would like to order repeat prescriptions or book appointments on line you will need a login and password set up.

If you would like us to set up a login and password for you, then please complete your information below and pass this into reception.  You will then be contacted with your login details, which you can use from the website.

Please do not hesitate to contact us if you have any questions or if you need your login or password reset.

Name		
Date of Birth		
Email Address		
Home Address	

We will shortly be launching a text message reminder service for any upcoming appointments. 

We will also use this service to send invitations to other clinics including Asthma, Diabetes, Heart Disease and Flu Vaccination. 

Text messages are generated using a secure facility. However it is important to understand that they are transmitted over a public network and as such may not be secure. 

The practice will not transmit any information which would enable an individual patient to be identified. 

We do not share your personal details with any external organisation other than health service providers.

Mobile Number 		

I consent to the Practice Contacting me by text message for the purpose of health promotion and invitation/reminder of appointments

Signature 		Date		

Please help us keep our records up to date

Do you smoke?					If you are a Current Smoker, are you:
(Please tick as appropriate)
Never Smoked					Light Smoker (1-9 / day)		
Current Smoker					Moderate Smoker (10-19 / day)
Ex-Smoker						Heavy Smoker (20-39 / day)