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.

Information about Overseas Visitors.

New Patient Registration (NEW)

New Patient Registration (NEW)

If you are human, leave this field blank.

When registering at the practice you will need a copy of photographic ID and proof of address

Patient's Details

Title *

Mr

Mrs

Miss

Ms

Other

Please state:

Forenames: *

Surname: *

Previous Surname:

Known as:

NHS Number:

Marital Status:

Occupation:

Date of Birth: *

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

Email Address *

Any responses we send will go to this email address.

Sex: *

Male

Female

Indeterminate

Home Address: *

Please include postcode

Town and Country of Birth: *

Home Phone Number:

Mobile Number:

Work Phone Number:

Do you consent to us contacting you by text message? *

Yes

No

Do you consent to us sending you non-clinical information via SMS?

Yes

No

Do you consent to us sending you clinical information via SMS?

Yes

No

Please remember to let us know if any of your contact details change

Height/Weight

Height:

Please record in centimeters

Weight:

Weight

kg

lbs

Previous GP

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

Your previous address in the UK:

Address of previous doctor:

Name of previous doctor while at that address:

If you are from abroad

Your first 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:

Please include postcode.

Service or Personnel Number:

Enlistment Date:

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

Next of Kin

Name:

Phone Number:

Relationship to you:

Next of kin contact details:

Are any of your family members registered at Windrush?

Yes

No

Which GP are they registered with?

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