Please help us trace your previous medical records by providing the following information:
If you are from abroad
If this is your first GP registration in the UK, please provide us the name of the country and date of arrival.
Please note that 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 or service charities services.
NHS Charges Regulations 2015 Self Declaration
Next of Kin
Your choice should be someone you feel close to. It does not have to be a blood relative or spouse. Before listing them on any medical documents, you should ask their permission and explain the role.
Communication and Access Needs
How many of the below do you smoke per day?
This is one unit of alcohol:
- Half pint of regular Beer/Lager/Cider
- 1 small glass of wine
- 1 single measure of spirits
- 1 single measure of aperitifs
- 1 small glass of sherry
Each of these is more than one unit:
- Pint of regular Beer/Lager/Cider (2 Units)
- Pint of Premium Beer/Lager/Cider (3 Units)
- Alcopop or can/bottle of regular Lager (1.5 Units)
- Can of Premium Lager/Strong Beer (2 Units)
- Can of super strength lager (4 Units)
- Glass of wine (2 Units)
- Bottle of wine (9 Units)
What is the date and result of your last Smear test?
Please specify what you are allergic to, what happens and when you had your first reaction
Please include dates
An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a decision you can make now to refuse a specific type of treatment at some time in the future.
For anyone aged 16 and over, we offer online services for appointment booking and repeat prescription ordering. This is the quickest and easiest way to order your medication. Once registered, you will also be able to view your summary record, detailing current medication, allergies and vaccinations.
You will soon receive an email from the practice with your log in details.
Summary Care Record
This record will contain summary information about any medicines you are taking, allergies you suffer from and any bad reactions to medicines you have had to ensure those caring for you have enough information to treat you safely.
Your Summary Care Record will be available to authorised healthcare staff providing you with care anywhere in England, but they will ask your permission before they look at it. This means that if you have an accident or become ill away from home, healthcare staff treating you will have immediate access to important information about your health.
Medical Record Sharing allows your complete GP medical record to be made available to authorised healthcare professionals involved in your care. You will always be asked your permission before anybody looks at your shared medical record.
Your Medical Information – Sharing Your Data
Under the General Data Protection Regulations (GDPR), we have a responsibility to keep your medical records confidential. We need your consent to share this with other authorised health professionals involved in your care or in planning your care. You can find more information on the website at www.nhs.uk/your-nhs-data-matters.
Please see the privacy notice on our website for more information on how your data is held and used by the practice.
The NHS wants to make sure you and your family has the best care now and in the future. Your health and adult social care information supports your individual care. It also helps us to research, plan and improve health and care services in England.
There are very strict rules on how this data can and cannot be used, and you have clear data rights. We are committed to keeping patient information safe and will always be clear on how it is used.
You can choose whether or not your confidential patient information is used for research and planning.
If you do not wish your information to be used in this way please opt-out by visiting NHS: Your Data Matters or by calling 0300 303 5678. The practice is unable to record this for you.
NHS Organ Donor registration
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: www.blood.co.uk or call direct on 03001232323