Request a My Health Online Account

My Health Online is an online service brought to you from NHS Wales. My Health Online offers patients the convenience to book appointments using the internet. At Pont Newydd Medical Centre, we allow patients to book, check and cancel appointments and to order medication online. If you wish to register to use My Health Online please fill in the boxes below. To protect patient confidentiality you must provide documents so we can make sure you are who you say you are. When you next visit your practice please confirm that you have completed this form and provide identification, preferably photo ID (e.g. driving licence or passport). Once your details have been verified, the practice is able to issue you a registration letter to create your My Health Online Account.

Last Updated: 01/10/2021

Your Details

Full Name *

Date of Birth *

Address *

Phone Number *

Email Address *

Consent

DO YOU CONFIRM THAT THE DETAILS YOU HAVE PROVIDED ARE CORRECT AND YOU ARE ABLE TO VERIFY THIS INFORMATION? *

I confirm that the details I have provided in this form are correct and I will bring a photo-id document of verification (e.g passport or driving license) on my next visit to the practice.

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

ONCE YOU SUBMIT THIS FORM, PLEASE REMEMBER TO BRING A PHOTO-ID DOCUMENT TO THE SURGERY ON YOUR NEXT VISIT TO VERIFY YOUR DETAILS.

Without verifying your details, the practice will not be able to issue you a registration letter.

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Request a My Health Online Account

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