New Patient Registration- Children Under 15

If you would like to register with the practice please use this form.

You will then need to visit the practice with two forms of ID: one for a proof of name and another for proof of residence.

To register a new patient you will need to live within our practice boundary.

New registration form - Children under 15

Out of area registration

If you live outside of the practice boundary area and you are applying to join the practice as it is in a more convenient location for you personally or you are re-joining the practice when you move home (to an area which is outside the practice boundary area) please consider the following-

1) If the doctors feel that it is not clinically appropriate or practical for you to be registered so far away from home then they can refuse registration

2) Because of the greater distance to your home, the surgery will not be responsible for providing you with a home visit when you are not well enough to attend the practice. You will be given information about what you should do in these circumstances should the need arise.

3) If your circumstances change and it is no longer clinically appropriate or practical for you to be registered away from home then you may be asked to register with a practice closer to your home where care may be better provided at the time.

 

Please sign below to confirm that you have read and understood the above statements:

Patient Details

Please use this format DD/MM/YYYY

Emergency Contact