New Patient Registration

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)
Your personal details

Information we need to register you with the practice
Please note all fields marked with a * are mandatory for your registration

If any
 
Processing
Your current address
 
Eg: "9PU"
 
Processing
Your contact details
 
Processing
Medical Records

Help us trace your medical records.

Please supply your previous full address in the UK (the address you used when last registering with a GP practice)

NHS Organ Donor Register

The law around organ donation in England changed to an opt-out system, to enable more people to save more lives.

This means that unless you choose to opt out, or are in an excluded group, you will be considered to have agreed to be an organ donor when you die.

The best way to make your decision known is to record it on the NHS Organ Donor Register and tell your loved ones.

FIND OUT MORE ABOUT ORGAN DONATION

Across the rest of the UK

NHS Blood Donor registration

Giving blood saves lives.The blood you give is a lifeline in an emergency and for people who need long-term treatments.

This means that unless you choose to opt out, or are in an excluded group, you will be considered to have agreed to be an organ donor when you die.

The best way to give blood is to apply using the NHS Blood Donor Register

FIND OUT MORE ABOUT BLOOD DONATION

We need

  • Nearly 400 new donors a day to meet demand
  • Around 135,000 new donors a year to replace those who can no longer donate
  • 40,000 more black donors to meet growing demand for better-matched blood
  • 30,000 new donors with priority blood types such as O negative every year
  • More young people to start giving blood so we can make sure we have enough blood in the future
 
Processing
About you
 
Processing
Significant Medical History
 
e.g. bowel cancer, breast cancer etc
 
This means someone who is unable to leave their home environment due to a physical or psychological illness
 
Processing
Medications

Please provide details of any medications you are currently being prescribed

Eg: Asthma, Diabetes etc
Eg: Asthma, Diabetes etc
Eg: Asthma, Diabetes etc

In an effort to support the NHS Paper Switch-Off Programme (PSO) we will no longer be printing prescriptions

 
 
Processing
Allergies

Please provide details

 
Processing
Family History
High Blood Pressure, Diabetes, Mental Illness, Stroke, Cancer, Heart Attack, Asthma etc
 
Processing
Carers
 
 
 
Processing
Your Personal Alcohol Consumption

1 unit of alcohol is 218ml cider standard 4.5% ABV, 76ml Wine Standard 13% ABV, 25ml Whisky Standard 40% ABV, 250ml Beer Standard 4% ABV or 250ml Alcopop Standard 4% ABV

Audit Score Result

you have a score of 

If you are drinking less than 14 units of alcohol per week, then your drinking is within the UK Chief Medical Officers' low risk drinking guidelines.

But if you are drinking regularly at or above the low risk guidelines of 14 units a week, or, you are drinking six or more units - if you are female - or eight or more units - if you are male - in one single session (binge drinking), please consider the increased serious risks to your health being caused by your current drinking pattern.

 
Processing
If you are from abroad
Please use this date format: DD/MM/YYYY
If you are returning from abroad

Previously been registered with the NHS in the UK

Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
 
Processing
Were you ever registered with an Armed Forces GP

Footnote: These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services

 
Processing
Supplementary Questions

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available at reception. Alternatively for more information go to the NHS Website

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate
action may be taken against me.

A parent/guardian should complete the form on behalf of a child under 16.

European Economic Area (EEA) Country

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

Please enter the details from your EHIC or PRC below.

S1 Form

Please give your S1 form to the practice staff.

How will your EHIC/PRC/S1 data be used?

By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

 
Processing
Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) is an electronic record of important patient information, created from GP medical records. It can be seen and used by authorised staff in other areas of the health and care system involved in your direct care.

Access to SCR information means that care in other settings is safer, reducing the risk of prescribing errors. It also helps avoid delays to urgent care.

As standard, the SCR holds:

  • Your name, address, date of birth and NHS number
  • Your current medication
  • Your allergies and details of any previous bad reactions to medicines

You can also choose to share an enhanced record. This is particularly useful if you are elderly, or have complex or long term conditions. The enhanced SCR holds:

  • Significant medical history (past and present)
  • Reason for medications
  • Anticipatory care information (such as information about the management of long term conditions)
  • End of life care information
  • Immunisations
 
 
Processing
Next of Kin

Please provide details of a friend or a relative we can contact in the case of an emergency. 

This must be somebody residing within the UK and they must have a British contact number.

Must be a British contact number
For example: Mother, Brother, Father, Friend
 
Processing
Application for Online Access

You can now book appointments, order repeat prescriptions and see some of the information in your GP records, including medications and allergies online.

The surgery has a responsibility to look after your GP records. You must also take care online and make sure your personal information is not seen by anyone who should not see it.

It requires you to upload a photo or scan of a Utility bill, passport, driving licence or Birth Certificate.

You can apply for online access at any time after registration either via our website or you can contact reception

Please contact the surgery after you have completed your registration to arrange Online Access.

Keeping your username and password safe

When you register to use Online Services, you will create your own username and password, which you will use to log in. You should not share your log in details with others.
To protect your information from other people:

  • You should keep your password secret and it is best not to write it down. If you must write it down, keep a reminder of the password, not the password itself. This should be kept in a secure place.
  • If you think someone has seen your password, you should change it as soon as possible. You may want to call the surgery if you are not able to change it right away, for example, when you do not have access to the internet.
  • You should not share your user name or password. No one should force you to show them your log in details, you have the right to say no. If someone forces you, tell the surgery as soon as possible.
 

Using a shared computer

You need to take extra care when using a shared computer to look at your records online. This could be at the library, at work, at university or at home. To protect your personal information from others  when using a shared computer. 
You should:

  • Look around to see if other people can see what is on the computer screen. Remember, your records contain your personal information.Look around
  • Keep your username and password secret. Just like your bank account PIN you would not want others to know how to get into your records.
  • Make sure you log out when you finish looking at your records so that no one else can see your personal information or change your password without your knowledge.
 

Incorrect information in your records

On rare occasions information in your records might be incorrect.

  • If you find any incorrect information you should let the surgery know as soon as possible.
  • If you see information about anyone else in your records, log out immediately and let the surgery know as soon as possible.

Patients under the age of 16 cannot have their own account
Patients over the age of 16 must have their own personal email account which cannot be shared

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
Processing

Page you are trying to access does not exist.