New Patients

Please fill in the registration form below. Your registration is usually processed within 24 hours (up to 48 hours) if the form is complete.

*NEW* New Patient Registration Form

Personal Details

Complete the registration form below with the details of the child

Please use this date format: DD/MM/YYYY
Please select your sex as recorded at birth.

Language Support

Contact Details

Have you lived at your current home address for more than 3 years?
Please use this date format: DD/MM/YYYY
 
 
Next of Kin

Child Under 16 Registration

Protection Plan/Foster Care Information
Parents/Carers Details

Mother/Carer
Father/Other Carer
Child's School Details
Please advise if the child has had any of the following immunisations (you can check your child's red book).

Age due: 8 weeks

Age due: 12 weeks
Age due: 16 weeks
Age due: 12 months

Age due: 3 years 4 months or soon after

Your Information

Summary Care Record

A summary care record (SCR) is an electronic summary of key health information. It will hold limited essential information derived initially from your GP record. This will include medication, adverse reactions and allergies. If you wish to know more information regarding the system and the benefits please ask reception. Alternatively, visit the website: www.nhscarerecords.nhs.uk or call 0845 603 8510

Sharing with other services

We may need to share your medical information with other organisations involved in the delivery of your care e.g. Podiatry or District Nursing. We will not share identifiable information with anyone that isn’t involved in your care unless legally required to.

If you selected Neither, you will need to complete the opt-out form on the NHS Digital website to fully opt-out. You can find the link to the NHS Digital opt-out form when you have completed your registration.

Please write your name or parent/carer for under 16s
Please use this date format: DD/MM/YYYY
Sending