Application forms are available from reception or on the link below.
If you wish to complete the form electronically, please click on the link below to open the form. When you have completed all of the details, either print a copy or send it to us as an email attachment to firstname.lastname@example.org or fax to 01484 543372.
Completing an application form is just the beginning of the process to register as a patient.
After emailing or dropping in your application form, please contact us after 48 hours and we can let you know if you are able to register with us, or if not, the reason why. It is rare that we do not accept new applications to our list but the GP does have the discretion to do so should he wish.
Note that by emailing the form you will be transmitting information about yourself across the internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.
Once accepted, you will need an appointment to see the Nurse or Healthcare Assistant for a New Patient Health Check. Until you have had this check you will not be registered as a patient and will not be able to see the GP except in exceptional circumstances. Patients who miss their new patient health check appointment will not be able to register with this surgery.
Don't forget if you need to be seen downstairs due to mobility issues, please let the receptionist know at the time of booking so they can make sure the downstairs room is free for you.
A copy of our practice leaflet is also available to download below.
New Patient Application Form
Practice leaflet A5 Dec 2017
Practice Leaflet Easy Read Nov 2016