Waiting List Registration
 

In order to provide for your care we need to collect and keep information about you and your health in your personal medical record. Please complete the following form carefully. The information will be used to create your personal medical record on the practice computer.

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Our practices are consistent with the Medical Council guidelines and the privacy principles of the Data Protection Acts.

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Submitting this form does not guarantee acceptance to the practice. A member of our team will contact you as soon as possible to advise if we currently have space on our list. If you are accepted as a new patient and have a chronic medical condition or take regular medications, we request that you arrange a registration consultation with a GP.

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​Please note that adults must complete their own separate form to register, however children can be included on a parent's application.

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If you would prefer to submit the form in writing, please contact reception for a form.

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