New Patient Registration - Adults
New Patient Registration - Adults
Please help us trace your previous medical records by providing the following information
Were you ever registered with an Armed Forces GP
If you need your doctor to dispense medicines and appliances*
* Not all doctors are authorised to dispense medicines
NHS Organ Donor registration
The law has changed so that you now need to opt out if you do not want to become a Donor. It is important that you talk to your family about your organ donation decision as they will be asked to support your decision. If you are undecided or do not want to become an organ donor please contact the NHS Organ Donation website at www.organdonation.nhs.uk or 0300 123 23 23.
NHS Blood Donor registration
All blood types are needed, especially O negative and B negative. Visit www.blood.co.uk or call 0300 123 23 23.
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 ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your 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.
NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS
Our GP Online Service
Please read the Do It Online Leaflet for further information (available from the main registration page)
Immunisations – Advise if you have had the following vaccinations, if you have please give date of last vaccination for
We have a high rate of HIV infection compared to the London and England average. As of 2018, our rate of diagnosed HIV is 8 in 1,000 residents. This is the 6th highest of a London borough. Estimates suggest that one in five people in London with HIV do not know that they have it. As of 2018, 44% of people in the borough diagnosed with HIV are diagnosed late and are already unwell.
If you like a test please speak to a receptionist Refusal: If despite medical recommendations if you do not want to have a test done then please let us know and we will make a record of it
Female Patients only
Eligible women for Smear Women are included in the cervical screening programme for the age of 25 to 64.
If you have not had a smear test in the last 3 or 5 years then please make an appointment with one of our practice nurse as soon as possible.
Having cervical screening at the recommended interval provides a low risk status rather than a no risk status of developing cervical cancer. A Cervical Information Booklet is available in English and number of other languages, you can find them on the NHS web site at: http://www.cancerscreening.nhs.uk/cervical/
Please let us know the method of family planning/contraception you use
Breast screening is offered to all women aged between 50 and 70 every three years. Breast screening (Mammography) is the most reliable way of detecting breast cancer at an early stage which saves an estimated 1,400 lives each year. Every year around 11,500 people die from breast cancer in the UK. To find out more visit: www.cancerscreening.nhs.uk To book for your Breast Screening appointment please call 020 3299 1964
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 and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.