New Patient Registration

We welcome new patients. If you would like to register with the practice please use this form. View our Practice Video to find out more about us!

We can only accept new patients who are within our inner boundary area, view our practice area map for more information.

Please allow 14 days for your application to be processed. All new patients should make sure they have at least one months’ supply of regular medications from their current practice before registering with us.

The Practice accepts applications from all patients to join the Practice regardless of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

Deer Park Patients

Patients who were previously registered at Deer Park Surgery are advised to check our practice area map to see if they are eligible to register with Windrush Medical Practice.

Information about Overseas Visitors.

NHSFamily doctor services registrationGMS1

Patient's Details

Radio Buttons *

Mr

Mrs

Miss

Ms

Surname: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

First Name(s) *

NHS Number:

Previous Surnames:

Radio Buttons *

Male

Female

Town and Country of birth: *

Home Address: *

Postcode: *

Phone Number: *

Please help us trace your previous medical records by providing the following information

Your previous address in UK: *

Name of previous doctor while at that address: *

Address of previous doctor: *

If you are from abroad

Your first UK address where registered with a GP:

If previous resident in UK, date of leaving:

Please use this date format: DD/MM/YYYY.

Date you first came to live in UK:

Please use this date format: DD/MM/YYYY.

If you are returning from the armed forces

Address before enlisting:

Service or personnel number:

Enlistment date:

Please use this date format: DD/MM/YYYY.

If you are registering a child under 5

Child Surveillance:

I wish the child above to be registered with the doctor named overleaf for Child Health Surveillance

If you need your doctor to dispense medicines and appliances

Not all doctors are authorised to dispense medicines

Dispensing:

I live more than 1 mile in a straight line from the nearest chemist

I would have serious difficulty in getting them from a chemist

NHS Organ Donor registration

For more information, please ask for the leaflet on joining the NHS Organ Donor Register

I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my death.

Kidneys

Heart

Liver

Corneas

Lungs

Pancreas

Any part of my body

Signature confirming consent to organ donation

NHS Blood Donor registration

For more information, please ask for the leaflet on joining the NHS Blood Donor Register

I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood.

Tick here if you have given blood in the last 3 years

Signature confirming consent to inclusion on the NHS Blood Donor Register

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Checkboxes *

Signature

Signature of behalf of Patient

Date: *