Online New Adult Patient Registration
Please kindly take a few minutes to fully complete this form as best you can.
To fully complete the registration process please email to us one proof of photo identification (i.e. passport/UK driving license/national idenfication card/travel document) and one proof of address (i.e. utility bill/telephone bill/credit card bill/tenancy agreement/council tax bill) dated within the last 4 months. Please email the images of your documents (i.e. scanned copies/pictures) in a standard format (i.e. pdf/jpeg) to email@example.com.
If you cannot email to us the above documents please do come in person and we will photocopy your documents and attach them to your file.
PLEASE ALLOW 2 WORKING DAYS TO PROCESS YOUR ONLINE REGISTRATION THEN BOOK AN APPOINTMENT IF YOU REQUIRE MEDICATION. IF YOU REQUIRE MEDICATION SOONER PLEASE SPEAK TO RECEPTION.
N.B Please be aware that if you are on highly addictive or controlled medications (i.e. tramadol, diazepam, temazepam etc) that we are unable to prescribe these medications until we have your old medical records, so please liaise with the reception to ensure we have these before booking an appointment. Please also note that we do not prescibe out of accordance with national and local medicines management guidelines.
For Details about the Summary Care Record, CIDR and Care.data please go to the following links:https://digital.nhs.uk/summary-care-records, https://cidrportal.nhs.uk/
*Please ensure you complete all the mandatory sections in order to be able to submit and process the application form. All the mandatory sections are starred *
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.