Western Urgent Care Booking System

23 October 2020



 

New User Details
Please select a user ID and a password
*UserID :
*Password :
*Repeat Password :
Personal Details
Title :
*Firstname(s) :
*Surname :
*Address :
*Town/City :
County :
*Postcode :
Contact Details
*E-Mail :
Alternative E-Mail :
You must enter at least one of Home or Work Telephone
*Home Telephone :
*Work Telephone :
Mobile :
Block Emails From Other Users :
Next of Kin Details
Name :
Telephone Number :
Relationship :
Blood Group :
Medical Conditions :
Alergies :
Current Medications :
GP Practice and Address :
 
* denotes required field

Notes

Please complete the form to the left. Fields marked with a * are mandatory.

User ID

For the User ID it is suggested that you use your surname and the first letter from your first name. The system will check to make sure that the ID is not already in use. If the ID is already in use, it is suggested that you use your firstname followed by the first letter of your surname. When entering your User ID the case of the letters is unimportant.

Password

Your password must be at least 8 characters long and must contain at least 3 of the following:
  • A lower case character
  • An UPPER case character
  • A number
  • A non-alpha-numeric character (_+=*%$@! etc.)
The password must not contain a simple word such as "password", "iloveyou", "master", "1234", "1111" etc.. Passwords are case sensitive. Your password is stored in a type of encryption which cannot be unencrypted. If your password is lost, you will need to request a password reset from the login screen.

Email Addresses

Please enter your email address. If you wish to receive copies of emails sent to an alternative email address (as well as the primary email address) please then enter an alternative email address. Please note that if you forget your password and wish to reset it, the password reset email is only sent to you primary email address.

Telephone Numbers

You need to enter at least one of your home or work telephone number. You may, of course, enter both. If you use a mobile number in one or other of these fields, please also enter the mobile number into the mobile number field.

Mobile Number

You may also enter your mobile number. If you have a mobile number it must be entered in the mobile number field.

hCaptcha

Please complete the hCaptcha box at the bottom of the form. This tries to ascertain that you are human and not a bot and stops spurious registration attempts.

Other

After you have completed the form, the details are sent to the site administrators and if everything is in order, will accept the registration. Once they have accepted your registration you will be informed by email (to the address you register on this form) and will be able to access the website with the UserID and password you have set.
 
 
 
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