New Patient Registration

New Patient Registration

You can be registered at the University of Warwick Health Centre if:

  • You are a current student of the University of Warwick
  • You are an Undergraduate living on Campus, within the catchment Area or in Kenilworth or Leamington
  • You are a Postgraduate living on Campus or within the catchment Area
  • You are a member of University staff living on Campus

You will only be registered after you have completed ALL of the required forms.

New Patients Only

You will need to register with the Health Centre as part of your enrolment. If living on Campus please complete all the information apart from your address; this will be supplied by the University following your arrival.

Students or members of staff with children need to register at the Health Centre. Please provide identification (Passport) and full immunisation history in English.

Following successful registration you will receive an email informing you which practice you are registered and the name of your accountable GP. You will be given details of our website where you will find all information about the practice.

IMPORTANT INFORMATION - BRITISH STUDENTS

YOU CAN SUBMIT YOUR REGISTRATION FORM AS PART OF YOUR ENROLMENT FROM THE 24TH AUGUST 2017. SO YOU REMAIN REGISTERED WITH YOUR HOME GP WE WILL NOT START TO PROCESS FORMS UNTIL THE 18TH SEPTEMBER 2017.

IMPORTANT INFORMATION - ALL STUDENTS

IF YOU DO NOT REGISTER WITH THE HEALTH CENTRE YOU WILL NOT BE ABLE TO USE OUR SERVICES UNLESS YOU HAVE A SERIOUS MEDICAL EMERGENCY 

DO NOT USE THIS FORM TO CHANGE YOUR ADDRESS

INSTRUCTIONS FOR COMPLETING FORM

Please complete the form ONLINE form as shown below:

1New Patient Registration

ALL QUESTIONS MARKED * ARE MANDATORY

If YES please enter your address below

IF NO ENTER UNIVERSITY OF WARWICK BELOW

IF YES ENTER YOUR ADDRESS BELOW

You must include your BLOCK, FLAT AND ROOM NUMBER

Please help us Trace your previous Medical records by providing the following information (UK STUDENTS ONLY)

If you are an international student you MUST complete the questions below

Declaration: I can confirm that the above information is correct.

NHS Blood and Organ Donor registration. If you would like to register please visit www.blood.co.uk or www.organdonation.nhs.uk

2Supplementary Questions

Patient Declaration - for all patients who are not ordinarily resident in the UK. Anybody in England can register with a GP practice and receive free medical care from that practice. However, if you are not ‘ordinarily resident` in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain` in the UK.Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.More information on ordinarily residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available form you GP Practice.

Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain` in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinarily residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available form you GP Practice.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

A parent/ guardian should complete the form on behalf of a child under 16.

I declare that the information I give on this form is correct and complete. I understand that is is not correct, appropriate action may be taken against me.

3Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section is you have an EHIC issued by the UK.

NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS

This code is located on your EHIC card
Section 3 on your EHIC Card
Section 5 on your EHIC Card
Section 6 on your EHIC Card
Section 8 on your EHIC Card
Section 9 on your EHIC Card

How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process. Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

4Health Information

You will not be registered without providing the information required below.

Accountable GP - All patients have been allocated an accountable named GP. You will be sent an email with the name of your GP following successful registration. This does not affect your ability to book an appointment with any GP. For more information please ask at reception.

If you have ticked any of the boxes above, you will need to book an appointment with the Practice Nurse for a review your earliest convenience.

We also offer a Health Check with one of our practice nurses to all patients who are on regular medication or are over 40 years of age.

5Accessible information

If yes, please complete the following:

Please note we will record the above information and add an alert message

6Summary Care Record

A Summary Care Record is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had. This information makes it easier for health care staff to treat you in an emergency or when your GP practice is closed.

7We offer free HIV Tests (Ask at reception for more information)

I have read the above. I confirm the information provided is a full and correct record of my medical history.

8FAST ALCOHOL SCREENING TEST

For the following questions – 1 standard drink = 1 unit of alcohol

An indication of a standard drink is as follows:

Half pint of regular beer, larger or cider.

Small glass of wine

Single measure of spirit

Single measure of aperitifs

Only answer the following questions if the answer above is Never (0), Monthly (1) or Less than monthly (2). Stop here if the answer is Weekly (3) or Daily (4).

Please type your total score below based on the answered provided in the FAST ALCOHOL SCREENING TEST

ALL QUESTIONS MARKED * ARE MANDATORY

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.

© University of Warwick Health Centre 2017
University of Warwick Health Centre, University Of Warwick, Health Centre Road, Coventry, CV4 7AL
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