Registration: Age 14+ Questionnaire

If you would like a New Patient Check Up with the nursing staff please book at Reception.

Please note: 
All new registrations require the completion of the GMS1 Form. Registrations cannot be processed without this.

1Registration: Age 14+ Questionnaire

Standard alcoholic unit = half a pint of beer, a 125ml glass of wine, a measure of spirit each count as one unit.

2Personal Medical History

3Drugs and Medicines

4Female Patients Only

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.

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Farley Road - 53 Farley Road, South Croydon, Surrey, CR2 7NG
Branch Surgery - 125 Holmbury Grove, Forestdale, Croydon, Surrey, CR0 9AQ
  • Telephone 020 8651 1222
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Your Neighbourhood Professionals. Just a Click Away! Selsdon & District Funeral Service Sarah Rutter Maura Cripps Holistic Therapy Evergreen Enterprises Probate and Wills
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