Under 16s New Patient Registration

PLEASE NOTE THAT IF YOU PLAN TO COME IN TO THE SURGERY WITH YOUR REGISTRATION PAPERWORK, YOU MUST COME IN AFTER 11 AM. THE RECEPTION DESK IS INCREDIBLY BUSY IN THE MORNINGS AND IN ORDER FOR THE REGISTRATION TO BE DONE CORRECTLY, WE NEED TO ENSURE WE ARE ABLE TO FOCUS ON YOUR PAPERWORK. WE WILL NOT TAKE ANY PAPERS BEFORE 11 AM.

After you have completed and submitted the form you must attend the surgery within 5 days with 2 forms of identification (ID). Please note we will not process the registration if you do not come back to the surgery in the week and will discard the documents.

Acceptable Identification; tenancy agreement, mortgage agreement, bank statement, driving licence, passport, birth certificate etc.

For the Donor registration please remember you must register for this yourself. If you fill this on the form it is for our information only. If you want to make sure its on the database you can do this by clicking on the link below. It only takes 2 minutes.

https://www.organdonation.nhs.uk/register-your-decision/register-your-details/

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Patient's Details

About You (Parent/Guardian)

Mobile number for text message reminders.

Carers Information

eg. someone who is ill, frail, disabled, has mental health/emotional support issues or substance misuse
eg. family member, friend or neighbour
Preferably a mobile number
eg. Wheelchair, hearing aid, braille, lip reading, sign language etc.

Ethnic Origin

Medical Records

Please help us trace your previous medical records by providing as much of the following information as possible.

If you are from abroad

Please include dates/years.