Child New Patient Registration

How to Register

You can register with the practice either online or in person. You will need to complete both the Purple New Patient GMS1 form and the Child Registration Form. This can be done by either completing this online form or by downloading and completing the documents below and then bringing them into the practice.

Please Note: Once you have completed the forms either online or printed them off you must come into the practice with 2 forms of identification to complete your registration. You can view the list of acceptable identification documents in the New Patient Registration Pack.

Child New Patient Registration

Your Child/ Young Person's Details

You can find this on a prescription or by contacting your GP.
Gender:
Mark N/A if this does not apply.

Family/ Guardians

Has Legal Responsibility? *
Next of Kin? *
Has Legal Responsibility?
Next of Kin?

Please provide a copy of Delegation of Consent Form if you are a carer.

Please state if they are also registered with the practice.

Child's Medical Background

Does your child/ young person need help with mobility/ communication?
Please select if any of the following apply to your child/ young person:
Include condition names, year diagnosed and whether this is an ongoing problem.
Include the Name, Doage and Frequency.
Is your child registered with a dentist?
Is your child/ young person known to Social Services?
Is your child or family currently involved with Children's Services?
Is your child/ young person a Looked After Child in the care of the Local Authority?
Is this?
Would you like an appointment to discuss this with your doctor?
Is your child being looked after by a friend, family member or neighbour in their home (Private Fostering)?
Is your child looking after someone at home?
Please let us know if your child is looking after someone who is ill, frail, disabled, has mental health/ emotional support needs or substance misuse problems.
Do you think they would like additional support as a young carer?
Would you like an appointment with your doctor to discuss this?

We have a social prescriber attached to our surgery who could offer you additional support. If you would like further details of the help available, please speak to one of our reception team

Please keep us up to date with any changes to your circumstances/ contact details etc. so we can ensure your records are kept accurate.

How we use your information

  • We collect and hold data about you for the purpose of providing safe and effective healthcare
  • Your information may be shared with our partner organisations to audit services and help provide you with better care
  • Information sharing is subject to strict agreements on how it is used
  • We will only share your information outside of our partner organisations with your consent*
  • If you are hapy with how we use your information, you do not need to do anything
  • If you do not want your information to be used for any purpose beyond providing your care, please let us know so we can code your record appropriately
  • You can object to sharing information with other health care providers but if this limits your treatment options, we will tell you
  • Our guiding principle is that we are holding your information in the strictest confidence
  • For more information about who our partner organisations are and how your data is used, please see the privacy notice on our website or please ask a receptionist for full details

*unless the health & safety of others is at risk, the law requires it or it is required to carry out a statutory function