Family doctor services registration (GMS1)

The practice covers the area of Alcester. If you change your telephone number or move locally, please ensure that you inform the practice, so that we have up to date information on you.

From the 5th January 2015 we can now accept out of area registrations. So if you are moving out of our area and would still like to be a patient here, just ring us and let us know. There are visiting restrictions to this but we are happy to discuss this with you. However if it is not clinically appropriate to continue to provide services under the Contract to the patient we may have to ask the patient to register to a closer surgery. Equally if you don’t live in Alcester or the surrounding villages but would like to register with us we can now offer this service.

Patients who wish to register with the Practice will be asked to show some form of identification such as a utility bill, or proof of residency in the UK. We will also need some proof of date of birth, so please show either your Passport or your Birth Certificate. You will also be asked to complete a Health Questionnaire. If you are suffering from a long-term illness such as diabetes or a heart condition.

To register with the practice you can either download our registration document below, print it out, complete it and then bring it into the practice.

Click here to download our Registration Form (.pdf)

Alternatively you can complete the online form below.

All patients over 16, can you please complete the New Patient and patient ethnic questionnaire.  We also need a copy of either a birth certificiate, passport or driving licence for everybody that is registering.  We ask that you print it off and drop it in to the surgery with your date of birth proof.  Many thanks.

New Patient Questionnaire  (.doc)

Paient Ethnic Origin Questionnaire  (.doc)

Patient’s details

Please provide in the format dd/mm/yyyy
If you know your NHS Number, please provide it

Please help us trace your previous medical records by providing the following information

If you are from abroad

If you are returning from the Armed Forces

If registering a Child under 5

If you need your doctor to dispense medicines & appliances

Not all doctors are authorised to dispense medicines

NHS Organ Donation registration

For more information, please ask at reception for an information leaflet or visit the website,
or call 0300 123 23 23.

NHS Blood Donor Registration

For more information, please ask for the leaflet on joining the NHS Blood Donor Register.

9 Confirm

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Your Neighbourhood Professionals
© Neighbourhood Direct Ltd 2017
Fields Park Drive, Alcester Warks, Warks, B49 6QR
Practice Website supplied by Oldroyd Publishing Group
Your Neighbourhood Professionals
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