Skip to main content Skip to accessibility tools

New Patient Registration

New Patient Registration

To register with us as a new patient, please complete the registration form below. We aim to process your registration within 48 hours.

PLEASE NOTE: Please do not complete this form if you are already registered with us – this form is for New Patients Only.

Are you completing this form for a child under 16 years old? Required
Required
Required
Required
Date of Birth Required
Europe/London
Sex at birth Required
Required
Required
Required
Do you need an interpreter?
Do you use any of the following?
Your address
Have you lived at your current home address for more than 3 years?
Required
Have you previously been registered with an NHS GP?
Were you born in the UK? Required
Required
Required

Next of Kin details

Your information

We would like to send you text messages to your registered mobile about your healthcare. This may include things like appointment reminders and test results. Is this OK? Required
Would you like us to send you appropriate emails from the surgery? Required

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: www.nhscarerecords.nhs.uk or call 0845 603 8510

Would you like to opt in to the Summary Care Record? Required
Are you happy for us to share your full medical records electronically with other services involved in your care? Required
Required
Back to Shakespeare Road Medical Practice
Return to header