Register – Child (Under 16)

New Patient Registration – Child (Under 16 Years Old)

Important Notice

In order to be fully registered with this practice, this form MUST be completed by the parent / guardian on behalf of the child.  Please note that children under 16 will not be registered unless a parent / guardian is also registered at the practice.

A parent / guardian will need to provide one of the following documents to complete the registration process:

    • the child’s birth certificate
    • legal documents
    • passport or other photo identification
This can be done by either uploading a clear photograph of on of the documents at the end of the registration form or by attending the practice in person.

Registration Form - Child

Child's Personal Details

Child's Background Information

School or Nursery Details

Child's Home Address

Child's Contact Details

Notification Consent

Child's Previous Details

Parent / Guardian Details

1st Parent / Guardian Details

2nd Parent / Guardian Details

Child's Medical History

Sight and hearing adjustments can be made at the practice




Important Notice

It is important that your child’s immunisations are kept up to date. A current copy of the immunisation history will help us to maintain their immunisation record.

Please either bring in your red book so that we can take a photocopy of this at reception or upload clear pictures of the immunisation history using the upload file links below.

Here is a list of the immunisations your child should have:

  • 1st Diphtheria, Tetanus, Whooping Cough, Polio, Hib , rotavirus* (age 2 months)
  • 2nd Diphtheria, Tetanus, Whooping Cough, Polio, Hib, rotavirus* (age 3 months)
  • 3rd Diphtheria, Tetanus, Whooping Cough, Polio, Hib (age 4 months)
  • 1st Pneumococcal (aged 2 months)
  • 2nd Pneumococcal (aged 4 months)
  • 1st Meningitis C (aged 3 months)
  • Hib/ Meningitis C
  • 1st Measles, Mumps, Rubella (MMR) (aged 12-13 months)
  • Booster Pneumococcal
  • Booster Diphtheria, Tetanus, Whooping Cough, Polio (aged 3 years 4 months)
  • Booster Measles, Mumps, Rubella (MMR)

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.


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.

Identification Upload

To complete your child's registration process, we require one of the following documents:

birth certificate

legal documents

passport or other photo identification

To speed up the registration process you can upload a clear picture of one these documents using the file upload function below, or you can bring this documentation to the practice in person.