Register for Online Services

We accept online requests for both Evergreen Life and Patient Access with choices to register with E-Life and Patient Access.

To register for our online services you will need to complete this form and will then be issued your username and password via email.

Once you are registered you will be able to use the service to:

  • Order your repeat prescriptions
  • Make an appointment
  • Cancel an appointment
  • Change your contact details
  • Review your medications and known allergies

Register for Online Services

Please use this date format: DD/MM/YYYY.
This service is for patients over 16 years old with their own email address. Email address must be unique and cannot be a shared address.

Please tick all that apply.
I wish to access my medical record online and understand and agree with each statement: