Child New Patient Registration

Please make sure you have enough medicine on hand before registering with us.

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

Please ensure that your child is a resident in our catchment area and living at the address provided to us before registering as a new patient with the practice.

To check if your child is in our area enter your postcode into our Postcode Checker.

It can take up to 5 working days for your registration to be completed, therefore please allow at least a week before making any appointment / repeat prescription requests.

Child New Patient Registration

Patient's Details

Title: *

Miss

Mr

Surname: *

Previous Surnames:

First Name(s) *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Sex: *

Male

Female

Not Specified

NHS Number:

Town and Country of birth: *

Home Address: *

Postcode: *

Please help us trace your child's previous medical records by providing the following information

Your child's previous address in UK: *

Please state 'N/A' if not applicable

Name of child's previous doctor while at that address:

Address of previous doctor:

If your child is from abroad

Your child's first UK address where registered with a GP:

If previous resident in UK, date of leaving:

Please use this date format: DD/MM/YYYY.

Date your child first came to live in UK:

Please use this date format: DD/MM/YYYY.

If you are registering a child under 5

Child Surveillance:

I wish the child above to be registered with the doctor named overleaf for Child Health Surveillance

If your child needs their doctor to dispense medicines and appliances

Not all doctors are authorised to dispence medicines

Dispensing:

My child lives more than 1 mile in a straight line from the nearest chemist

My child would have serious difficulty in getting them from a chemist

If you are human, leave this field blank.