• New Patient Registration Questionnaire(Child: Under 16 Years Old)

  • Patient Details

  • About you (Parent/Guardian)

  • If you have clicked other

  • Carers Information

  • Medial Records

    Please help us trace your previous medical records by providing as much of the following information as possible.
  • Past Medical History

  • Vaccination History

  • Please provide us with information about any immunisations your child has received. This is essential if they have received any vaccinations overseas.

    If you are not sure which vaccinations your child has had, it would be helpful to bring along any records (eg your child’s red health book) when you next come to the surgery.

  • Sharing your child's medical record

  • Medical record sharing allows your complete GP medical record to be made available to authorised healthcare professionals involved in your child’s care. You will always be asked your permission before anybody looks at the shared medical record.

  • Summary Care Records contain details of your child’s key health information – medications, allergies and adverse reactions. They are accessible to authorised healthcare staff in A&E Departments throughtout England. You will always be asked your permission before anybody looks at your child’s Summary Care Record. Ask your GP about the optional “Additional Information” choice.

  • NHS Organ Donor Registration

  • Permission

  • Should be Empty: