New Patient Registration

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

Once you have completed the form, please visit the practice with:

  • Proof of current address
  • Two forms of ID (one must be photographic)

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 - Adult

New Patient Registration - Adult

Patient's Details

Have you checked that you are within our practice boundary? *
Title *
Gender *
Please use this date format: DD/MM/YYYY.
Has the patient been known by any other names? *
If known
Does the patient speak English? *
Ethnic Origin: *

Previous details

Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK
Please use this 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

Disability

Are you registered:
Blind?
Partially Sighted?
Deaf?
Speech Impaired?

Ex Services

Please use date format DD/MM/YYYY
Please use date format DD/MM/YYYY

Medical History

Heart Attack/Angina (under 60)
Heart Attack/Angina (over 60)
Stroke
Diabetes
Asthma
Do you have any drug allergies?
If you have never been registered with a GP in the UK previously, please give details of any illnesses or hospital treatments:
Please include dates

Lifestyle

How active are you? ? *
Do you consume alcohol? *
1 Pint of Beer 4% vol = 2 Units, 1 Bottle of Strong Beer = 3 Units,1 Large glass of Wine = 3 Units, 1 Bottle of Wine = 9 Units. 1 Bottle of Spirits = 30 Units
Did you previously drink alcohol? *
Please use date format DD/MM/YYYY
Do you smoke? *
Would you like smoking cessation advice? *
Did you smoke? *
What did you smoke?

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 and hand it in.

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 one, two, three or all four

Consent Policies

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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.

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