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


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. 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. Just a Click Away! Maura Cripps Holistic Therapy Evergreen Enterprises Probate and Wills Selsdon & District Funeral Service Sarah Rutter
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! Maura Cripps Holistic Therapy Evergreen Enterprises Probate and Wills Selsdon & District Funeral Service Sarah Rutter
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