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New Patient Registration

To register on our list, you must live in our area and can prove that you have lived in this country for over six months. You will be asked for proof of residence. Under no circumstances will this practice refuse an application based on your gender, social class, age, religion, disability, appearance or medical condition. Our policy on this matter is outlined below.


To register on the surgery list, you must fill in a surgery registration pack, provide your NHS number and name of your previous surgery. You will also be asked to provide proof of your identity and proof of your residence.

After submission of form and confirmation of your identity it takes 4 working days to register you fully at the Surgery. Once registered, you can then make an appointment if needed. Patients on regular repeat medication should make an appointment before they are due to run out of medication to see a GP.

Anti-Discrimination Policy

The surgery has a robust anti-discrimination policy for all stakeholders which includes patients, their relatives, visitors to surgery and all staff members. The policy covers all aspects of anti-discrimination relating to race, religion, creed, gender, age, appearance, disability, social class and medical conditions. The surgery has clear guidelines for the diversity and offering of equal opportunities and equality to all stakeholders.

Summary Care Records
Your Medical Records – Your Decision

The NHS has a computer system called the Summary Care Record (SCR). The Summary Care Record is designed to help emergency doctors and nurses when you contact them, if the surgery is closed. Initially, it will contain just your medications, adverse reactions and allergies. However, later on as their computer system (known as the “NHS Spine”) develops, many other people who work in the NHS will be able to access your records with your permission: e.g. information from hospitals, blood tests, x-rays and specialists’ letters. The information will be sent from practices such as ours and held on NHS databases. As with all new systems there will be pros and cons; when you speak to an emergency doctor you might overlook something that is important and if they have access to your medical record it might avoid mistakes or problems. On the other hand, there is not much evidence that these sorts of systems dramatically improve care. Having all your personal medical information in one place can increase the risk of others accessing it without permission (known as `hacking`) or information being lost or misplaced.

The purpose of this factsheet is not about whether you should have your data on the Summary Care Record or not. It is about your right to control what’s happening to your care records. Connecting for health, the government agency responsible for the Summary Care Records have agreed with doctors` leaders that patients registering with this practice should have absolute control over whether or not their records are available on the Summary Care Record. However, for patients already registered with a practice it is assumed you want a Summary Care Record.

This practice believes eveyone should have the same control. The British Medical Association also believes patients medical records should not be uploaded without explicit patient/carer consent.

What are my options?

  1. I DO want to have Summary Care Records (SCRs). I am happy for my SCRs to be sent to it
  2. I DO NOT want a Summary Care Record. I am not happy for my records to be sent to it.

What happens next?

  • If you choose option 1, We will set our system to create a SCR for you.
  • If you choose option 2. We will set our system to NOT create a SCR for you.

Please indicate on the following form which option you would like us to create for you.

Where can I get more information?

Information from Connecting for Health, the government agency that is responsible for the Summary Care Record, is being posted to you by your local Clinical Commissioning Group. Additional information can be found at Alternative views from people who have concerns about centrally managed computer systems can be  found at

Section A
Can be taken at some local pharmacies/with an at home BP machine
Section B

Please help us trace your previous medical records by providing the following information

Were you ever registered with an Armed Forces GP

Footnote: These questions are optional, and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities.

Section C

If you need your doctor to dispense medicines and appliances (Not all doctors are authorised to dispense medicines)

Section D

NHS Organ Donor System:

The law around organ donation in England has changed. All adults in England are now considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the excluded groups. It is really important that you choose whether you want to be a donor and discuss what you want to happen with your family, so your decision is clear and they can have peace of mind knowing that your decision is being honoured. If you would like more information about the NHS Opt Out System, please, call 0300 303 2094 or consult the website

Section E

NHS Blood Donor registration

All blood types are needed, especially O negative and B negative. Visit or call 0300 123 23 23.

Section F

SUPPLEMENTARY QUESTIONS - These questions and the patient declaration are optional, and your answers will not affect your entitlement to register or receive services from your GP.

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.

Section G

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.


Please give your S1 form to the practice staff.

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.

Section H








Is there any of the following in your family (father, mother, brother, sister) before age of 65 (if so please provide which family member/s)







(the receptionist can help with these arrangements)
HIV Test

All adult patients in London are now being offered a free HIV test when they register with a new GP. The Department of Health recommends this as 100,000 people in the UK are now living with HIV, half of them live in London, and 1 in 5 are unaware they have it. Free effective treatment is available now to all on the NHS regardless of immigration status. If you would like to have a blood test done please ask your doctor or nurse at your next consultation.

Please arrange at reception

Next of Kin Details
Summary Care Records (SCR)

If you do not select one of the above options, you will automatically be agreeing to opt in to have Summary Care Records.

For Female Patients Only

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 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.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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