Online Registration Forms
If you wish to pre-register, you need to complete the following 2 online forms, the pre-registration form AND the medical questionnaire, to do this simply click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. When you visit the surgery for the first time you will be asked to sign the form to confirm that the details are correct.
You will also NEED to complete the below medical questionnaire. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too, which you may fill out and send to us. When you come to the surgery you will be asked to sign this form to confirm that the details are correct.
Online Medical Questionnaire For New Patients
Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.
SCR Consent Form / SCR Info
The Summary Care Record is a copy of key information held in your GP record. It provides authorised healthcare staff with faster, secure access to essential information about you - when you need unplanned care or when your GP practice is closed. The availability of Summary Care Records will improve the safety and quality of your care.
You will need to complete the attached SCR Consent Form whether to opt in or out of the service, depending on whether you would like your information shared with other services in order to provide you the best care. If you are unable to print this form, you will be asked to call into the surgery to complete this before we can get you registered.
Please find letter below, this is for your information when registering as a new patient.
We have 1 GP here at the surgery, which is Dr A Zarrouk, he will be your accountable GP.
Dr Zarrouk Accountable GP
Request to Register for Online Services (mysurgerywebsite.co.uk)
From the 31st October 2023 all surgeries should be offering access to full medical records - our surgery now has this switched on from 18th October 2023.
If you wish to have access to online services you will need to complete the attached form. Once we receive this request we will review your request and if successful, you will need complete a further form which shows you understand the request.
Please find information sheet below:
Accessing your GP records
Are you a carer?
A carer is classed as someone, either an adult or a child, who is caring for a family member, relative or a friend who would be dependant on their care. For example, if the carer was to become ill, the person who was being cared for would be at risk with no one to care for them.
We wouldn't include those who are a carer by occupation unless they were a carer for their own relative, nor someone who carers for their own child.
If you think you identify yourself as a carer, we would love to have you on our carers register at the surgery. Please complete the form below to be added:
Are You A Carer? (mysurgerywebsite.co.uk)
Carers are at a much higher risk of becoming ill themselves and your GP can help keep you fit and well by recognising the effects caring can have on your health, such as depression, stress, high blood pressure or back pain. Make sure you take advantage of the free NHS health checks if you are eligible for one and if not discuss any health concerns with Dr Zarrouk.
Alternatively you may print off both the GMS1 registration form, the patient questionnaire, online access request AND the SCR consent form below, fill them out and bring both forms in with you on your first visit to the practice. Both need to be completed along with ID and proof of address.
Mandatory Patient Questionnaire - for adults aged 18+
Mandatory Application Form for Online Access
Mandatory SCR consent form
Children under 18
Mandatory Child Registration Form 2023 - for children up to 18
Mandatory Notification of Newly Registered Family - for families
Also, some useful information regarding our practice: Practice Leaflet 2023.doc