Re-registration for Adults and Children
This form is only for those whom have previously been registered at our surgery and returning back and are ordinary residents in the UK. 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 email@example.com.
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:
*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 CHILDREN WILL ONLY BE RESGISTERED IF ONE OF THEIR PARENTS/MAIN CARER ALSO IS AT OUR SURGERY.
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.
About your Health
FORM COMPLETION SIGNATURE
Patient Participation Group
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.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.