Register – Adult (16+)

Registration Form - Adult (16 Years Old & Over)

Personal Details

Background Information

Home Address

Contact Details

Notification Consent

Previous Details


Armed Forces


We recommend that patients obtain accurate weight, height, weight and blood pressure measurements using the machine in reception (available at both sites)

Medical History

Sight and hearing adjustments can be made at the practice

Electronic Prescribing

The Electronic Prescription Service (EPS) is an NHS service that sends electronic prescriptions from GP practices to pharmacies allowing you to choose where you get your medications or appliances from.

Latent Tuberculosis Testing

The Practice is working with Public Health England, NHS England, Acute Hospitals and Local Authorities to deliver a comprehensive service to:

  • Screen, identify and treat patients with latent tuberculosis (TB) infection
  • To reduce the spread of the disease
  • To reduce activation of TB and thereby reduce the spread of TB

Please would you answer the following questions:

If you have ticked any country above, please complete the following:


What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that have access to your records are covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

My Data Matters

If you do NOT wish the NHS to share data from your health records for the purposes of research and planning, please opt out on the NHS website.

Summary Care Records (SCR)

These are an electronic record of important patient information, created from GP medical records. They can be seen and used by authorised staff only; in other areas of the health and care system involved in the patients care.

To opt out, visit

NHS Organ Donor Registration

For more information on organ donation, please visit:

NHS Blood Donor Registration

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: or call direct on 03001232323

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.