New Patient Registration

New Patient Registration
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Patient’s Details

Name
Name
First Names
Surname
This must be a UK number
This must be a UK Number
Are you happy for us to contact you by text message?
Are you happy for us to contact you by letter?
Are you happy for us to contact you by email?
Please provide an email address as we aim to increasingly use this to communicate with patients

Please help us trace your previous medical records by providing the following information (If you do not have a previous UK address or NHS GP please enter N/A)

Are you from Abroad?

Are you from abroad?

Ethnicity

We want everyone, no matter what their ethnic group, religion or culture, to be able to use our services. Providing this information helps identify some groups at greater risk of specific diseases, e.g diabetes

Language

Do you speak English?
Can you read English?
Do you need an interpreter when you see the doctor?
Are you an Asylum seeker?
Are you a refugee?
Are you homeless?

Members of the Armed Forces & Veterans

Are you returning from the armed forces?

Getting to the practice

Are you housebound and unable to get to the practice?

NHS Organ Donor registration

For more information, please ask for the leaflet on joining the NHS Organ Donor Register.

For more information on organ donation please visit: www.organdonation.nhs.uk

NHS Blood Donor registration

For more information, please ask for the leaflet on joining the NHS Blood Donor Register.

If you would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood, please visit their website on: blood.co.uk.

Supplementary Questions

PATIENT DECLARATION for all patients who are not ordinarily resident in the UK