It is of enormous benefit to the Doctors and Nurses to know something about your child's medical background when you visit the practice since we may not have received your child's notes from your previous practice for some time.
Please note all fields marked with a * are mandatory for your registration

What does "nominate a pharmacy" mean for me?

Please submit birth certificate as proof when prompted.

These are supplementary questions and your answers will not affect your registration with us

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available at reception. Alternatively for more information go to the NHS Website 

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate action may be taken against me.

Previously been registered with the NHS in the UK

LIST OF EEA COUNTRIES

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

Please enter the details from your EHIC or PRC below.

A carer is anyone, including children and adults who looks after a family member, partner, or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.

This does not mean your normal parenting duties for your child

If you do not return this form, a Summary Care Record will be created for you based on implied consent

Dear Patient,

There are currently three different data sharing schemes running nationally; Local Data Sharing, the Summary Care Record and NHS Digital Data and Information Collection data sets.

It is important that patients know the difference between Local Data Sharing, the Summary Care Record and NHS Digital Data and Information Collection data sets, so that an informed choice can be made about whether you are happy for your data to be shared, or whether you wish to opt out.

We want to be sure that we give you the opportunity to decide at what level you would like to opt out of data sharing and are aware of the implications.

You can also opt out of receiving text messages from the surgery. The surgery sends texts relating to your appointments, health reminders or campaigns. Please ensure we have your correct mobile number if you want to receive these texts.

Please complete the attached form and return it to us so we can be clear about your wishes.

A data sharing agreement exists between other clinical services that we refer you to. There are local services that are run as a federation of practices; caring for patients and providing cover Monday to Sunday 8-8 at the Hub.

If a patient does not opt out, their information will be shared when immediate patient care is needed.

A Summary Care Record is an electronic record that is stored at a central location. It contains information about medicines, allergies, or reactions to medicines that a patient has had. The record does not include detailed information about a patient’s medical history. Only healthcare staff directly involved in the patient’s care who have access to this information. Having this information stored in one place makes it easier for healthcare staff to treat patients in an emergency. The information being shared could be critical in an emergency situation. If a patient does not opt out, they will automatically have a Summary Care Record; however a patient can opt out of or re-join the scheme at any time.

The NHS would like to link information from all the different places where patients receive care, to help them compare the care patients receive in one area against another, so they can see what has worked best. Information such as a patient’s postcode and NHS number, but not their name, will be used to link their records in a secure system, so their identity is protected. Information which does not reveal their identity can then be used by others, such as researchers and those planning health services, to make sure the NHS provide the best care possible for everyone. How patient information is used and shared is controlled by law and strict rules are in place to protect patient privacy. If a patient does not opt out, their information will be shared; however a patient can opt out of or re-join the scheme at any time.

What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.