Adult 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

I declare to the best of my belief this information is correct. An audit trail is available at the practice for inspection by the HA’s authorised officers and auditors appointed by the Audit Commission.
Please use this date format: DD/MM/YYYY.

Ethnicity

Next of Kin & Other Relatives

Please include name, relationship & DOB.

Carers

Wheelchair/hearing aid/braille/lip reading etc.

Medical Records

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

If you are returning from the armed forces

Please use this date format: DD/MM/YYYY.

If you are from abroad

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.