Online New Adult Patient Registration
Dear Patient,
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 register.whmc@nhs.net.
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 3-4 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, HIE (Health Information Exchange) and Care.data please go to the following links:
https://digital.nhs.uk/summary-care-records
https://www.northlondonpartners.org.uk/joined-up-care-record?=
*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 *
Please note that if you are outside of the practice map area and are likely to require home visits i.e. housebound/mobility issues, then please register with a practice more local to you.
Please help us trace your previous medical records by providing the following information
If you are from abroad (please go to the section if this does not apply to you)
If you are returning from the Armed Forces (please go to the section if this does not apply to you)
About your health
NHS Organ Donor registration
NHS Blood Donor registration
FORM COMPLETION SIGNATURE
Supplementary questions for all patients whom are not ordinarily resident in the UK (please go to the section if this does not apply to you)
Complete 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 if you have an EHIC issued by the UK
Thank you for taking the time to complete this form
VIRGIN ACTIVE 02 CENTRE FREE DAY PASS
Patient Participation Group
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
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Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.