New Patient Registration

Registration is with the practice but to provide continuity of care you will have a named doctor who will be responsible for you and your family. We believe this provides sound holistic care that you would expect.

Registration documents are normally dealt with between 2.00 and 3.30pm to free our busy reception desk in the mornings.

Change of address and personal details should be notified to the practice in writing. Patients moving out of the practice area may be requested to register within their locality.

You can either complete the online registration form below, or click here to download the registration form.  If you download the form please return the completed form to the practice.

Personal Details
Next of Kin
Include First Name and Surname
Medical Details

Please estimate if unknown

Language Support

Do you look after a sick, disabled, frail relative or friend without payment? Is there a child or young person in the family who helps to provide care or support to another family member? Approximately 10% of the current population are carers. In order to help us update our Carers Register please spend a few minutes of your time completing this information.

Alcohol Consumption
NHS Organ Donor Registration

For more information, please visit

NHS Blood Donor Registration
Other Details
Your Information Summary Care Record

A summary care record (SCR) is an electronic summary of key health information. It will hold limited essential information derived initially from your GP record. This will include medication, adverse reactions and allergies. If you wish to know more information regarding the system and the benefits please ask reception. Alternatively, visit the website: or call 0845 603 8510

Sharing with other services

We may need to share your medical information with other organisations involved in the delivery of your care e.g. Podiatry or District Nursing. We will not share identifiable information with anyone that isn’t involved in your care unless legally required to.

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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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.

Your Neighbourhood Professionals. Just a Click Away! BMI The Clementine Churchill Hospital
Your Neighbourhood Professionals. Just a Click Away! BMI The Clementine Churchill Hospital