New Patient Registration – Child or Young Person

If you would like to register with the practice please use this form.

Please note: We can only accept the child’s registration if a parent is also registering at the same time or is already a patient at the practice.

Once you have completed the form, please visit the practice with the child’s birth certificate.

If you do not bring these to the practice within 7 working days, your application will be void.

We recommend that you book a 10 minutes New Patient Check appointment with one of our Health Care Assistants.

If you are on any medication, you will need to book a medication review with one of our GPs or pharmacist before requesting anything from us.

To register a new patient you will need to live within our practice boundary.

New Patient Registration - Child or Young Person

Patient's Details

Have you checked that you are within our practice boundary? *
Details of the child or young person being registered;
Title *
Gender *
Please use this date format: DD/MM/YYYY.
Has the patient been known by any other names?
If known
Is the patient home schooled?
Does the patient speak English?
What is your ethnic group? *
Which one best describes your White background? *
Which one best describes your Mixed background? *
Which one best describes your Asian or Asian British background? *
Which one best describes your Black or Black British background? *
Which best describes your other ethnic group background? *

Previous Details

Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK
Please use date format DD/MM/YYYY

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use date format DD/MM/YYYY
Please use date format DD/MM/YYYY

Details of Child's Main Carer

i.e. The person who has LEGAL parental responsibility for the patient (a definition of Parental Responsibility is available here)

Any responses we send will go to this email address.
Please tell us your preferred method of contact: *
Do we have permission to send you text messages? *

Who else has Legal Parental Responsibility?

Families Receiving Additional Support

Does the patient have a social worker? *
Is the patient on the Child Protection/Child in Need Plan? *
Is the patient in a care/foster home? *

Medical History

Does the patient have any disabilities or distinguishing features?
Is the patient on any repeat medication?
Does the patient suffer from any allergies?
Are the patients Child Immunisations up to date?

Lifestyle

Is the patient a smoker?
Does the patient consume alcohol?

Your Summary Care Record and the Sharing of Information

It is important that those caring for you have access to your medical information so they can treat you safely and effectively. Many patients think that if they are seen at a Hospital, by the Ambulance Service or by a District Nurse they can see the notes written by your GP. In most cases this doesn’t happen! Sharing your record for your care can only happen when you tell your GP Surgery that it’s ok.
How do I make my record available to other staff involved in my health care?
Simple. You complete this form.
A - Summary Care Record with Additional Information
Anyone registered with a GP practice in England, will have a “Summary Care Record” unless you have chosen not to. It includes: Current medication/ Allergies and details of any previous bad reactions to medicines / Your name, address, date of birth and NHS number.

However, unless you have specifically asked for “Additional Information” to be included, health and care professionals who do not know your medical history may not have the following:
Significant medical history (past and present) / Reason for medication / Anticipatory care information (such as information about the management of long term conditions) / Communication preferences / End of life care information / Immunisations

B - Full Electronic Health Record
Your full electronic health record from your GP Surgery can also be made available to health and social care staff. They will only be able to see this if they are involved in your direct care, and they must still ask for your permission before they look at it. This will also allow your GP Surgery to see what’s recorded about you when you’re seen elsewhere. If there are certain parts of your record that you wish to keep private, your GP Surgery can help with this.
C - Receiving messages via text
You can receive communications from your GP Surgery by letter and phone, however you have to give consent to receive text messages from the GP Surgery to your mobile phone. This includes; appointment reminders, test results, messages relating to your specific health need (e.g. a flu vaccination reminder), general health information that could benefit you, information about emergencies (e.g. winter pressures). Your phone number will not be provided to third parties.
D - Receiving messages via email
You can receive communications from your GP Surgery by letter and phone, however you have to give consent to receive messages from the GP Surgery to your email address. This includes; appointment reminders, test results, messages relating to your specific health need (e.g. a flu vaccination reminder, diabetic management plans), requesting you contact the GP Surgery if they have tried to contact you by telephone, general health information that could benefit you, information about emergencies (e.g. winter pressures)
Your email address will not be provided to third parties.
Your Decision – You can agree to however many of these options:

Consent Policies

Consent Policy for leaving messages and/or texting on the patients contact numbers
Please complete this consent form which will be saved on your GP record. You can notify us in writing if you wish to retract this at any time.
*

Access to Medical Records Online
It is now a requirement that all newly registered patients have access to their medical records online. It is your choice if you wish to use this online access.
Once you are registered with the surgery you will receive two text messages one with your online username and the other with your online password.
To ensure you will receive these messages please give us an up to date mobile number and sign below to consent to us sending you appropriate SMS messages.

Consent to share information

Those with parental responsibility for children under the age of 13 yrs will automatically have the right to view their child’s medical record and share information with medical professionals.
At this practice we will share medical records for children up to the age of 16 yrs with those who have parental responsibility. Above the age of 16 yrs we will not release medical information even to those with parental responsibility unless express consent is given by the child.

However above the age of 13 yrs of age children can request not to share medical information even to those with parental responsibility, if they have the capacity (understanding of the consequences of their decision) should they wish, except in the instance of safeguarding information (if a child was at risk of abuse or exploitation).

Please speak with reception should you require more information.

*
Please bring the patient's birth certificate to the practice within 7 days to register, so that a copy can be taken.