Schopwick Surgery

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Child (under 16) New Patient Registration

In order for us to register you, please check that you are within our Practice Area here and enter your postcode.

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.

New Patient Registration – Child

Patient’s Details

Please complete text boxes as accurately as possible and select options where appropriate.
Please state as it appears on your passport
Please state as it appears on your passport
Please use day/month/year format. e.g. 04/10/2014
Enter Email
Confirm Email
Can we contact you by text? *
Can we contact you by email? *
Please use day/month/year format. e.g. 04/10/94

Patient’s Previous Details

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

Parent/Guardian Details

Are you next of kin?

Parent/Guardian Details

Are you their next of kin?

Allergies

Do you have any allergies?

Ethnicity

Please specify the ethnic group you consider you belong to *

Health

Does your child take regular medication?
Does your child have any long-term illness, health problem or disability?
Please make an appointment for a new patient health check.

Immunisations

For all children aged from 8 weeks to 5 years we require a copy of their immunisations from your red book to process the registration.  These can either be uploaded via the website using the ‘Upload a Document’ button or brought into the surgery where we will take a copy from you. 
 
Please note, your child’s registration will not be processed until we have this information.

Electronic Prescribing

The Electronic Prescription Service (EPS) sends electronic prescriptions from GP practices to pharmacies. Eventually EPS will remove the need for most paper prescriptions.

Health Professionals

Does your child have contact with any of the following?
Has your child ever been under a Child Protection Plan?

Brother/Sisters/Siblings

My Data Matters

If you do NOT wish the NHS to share data from your health records for the purposes of research and planning, please opt out on the NHS website.

Summary Care Records (SCR)

These are an electronic record of important patient information, created from GP medical records. They can be seen and used bu authorised staff only; in other areas of the health and care system involved in the patients care.

To Opt Out, visit www.digital.nhs.uk/scr

NHS Organ Donor Registration

For more information on organ donation, please visit: www.organdonation.nhs.uk

What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.