Child (under 16) New Patient Registration

All patients wishing to register with the practice:

In order for us to register you, please can you check that you are within our Practice Area by telephoning the Surgery on 0844 477 2400 or 0203 667 1850. Once confirmed you will be required to fill in a registration form AND provide proof of identity (photo identification) AND address.

All babies/children 5 and under, parent/guardian will need to provide birth certificate/legal document to register at the practice.

All children over 5 – 16, parent/guardian will need to provide either birth certificate/legal document or photo ID to register at the practice.

Interested in joining our Patient Participation Group? Download and complete our PPG Membership Application Form

Patient's Details

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

Previous Details

Please include postcode.

If you are from abroad

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

Parent/Guardian Details

Allergies

Nationality

Health

Please make an appointment for a new patient health check.

Language

Immunisation History

Please include dates.

School or Nursery

Health Professionals

if so, please can you tell us their names

Brother/Sisters/Siblings

NHS Organ Donor registration