New Patient Registration

If you would like to register with the practice please use this form.

You will need to live within our catchment area to register as a new patient at Paxton Green Group Practice.

After you have completed this online form and attached the necessary proof of identification you will be contacted by the practice to arrange a video meeting to confirm your identification.

Child Registration Under 5

In addition to proof of address, you will need to bring in your child’s Red Book (Personal Child Health Record) or provide us with a certified record of previous immunisations. Immunisation records are very important for the well-being of your child: collecting this information will ensure that we have an up to date record, including when the next vaccinations are due.

Registration of your Baby and Post Natal Care

If you are already registered with us and have just had a new baby, Paxton Green Group Practice would like to welcome your new baby to the practice and ask you to register your son or daughter with us as soon as possible.

Please complete this online registration form with your child’s NHS number and a contact phone number. Once we have received your online registration form we will contact you to arrange a post-natal check and baby’s first injections.

New Patient Registration

New Patient Registration

If you are human, leave this field blank.

In order to complete your registration, please ensure that you have your driving license and passport available.

Patient's Details

Title *

Mr

Mrs

Miss

Ms

Other

Please specify:

Surname: *

Previous Surnames:

First Name(s) *

Date of Birth: *

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

NHS Number:

Sex: *

Male

Female

Indeterminate

Home Address: *

Postcode: *

Town and Country of birth: *

Home Phone Number:

Mobile Phone Number:

Work Phone Number:

Email Address: *

Can we contact you by text?

Yes

No

Can we contact you by email?

Yes

No

Ethnicity

Please specify the ethnic group you consider you belong to:

White British

White Irish

Other White

Black Caribbean

Black African

Other Black

Black Caribbean and White

Black African and White

Other Mixed

Indian

Pakistani

Bangladeshi

Other Asian

I do not wish to state

Other ethnic group

Please state:

Do you speak English?

Yes

No

Do you read English?

Yes

No

First Language:

Emergency Contact

Full Name:

Relationship to you:

Phone Number:

Are they your Next of Kin?

Yes

No

Do you give us permission to discuss your medical records with them?

Yes

No

Electronic Prescription Service

The practice can send your prescription to your preferred pharmacy, please give us the name of this nominated pharmacy.

Pharmacy Name

Pharmacy Address:

Pharmacy Postcode:

Allergies

Do you have any allergies?

Yes

No

Please specify what you are allergic to, what happens and when you had your first reaction:

Previous Details

Previous address in UK:

Please include postcode.

Name and address of previous GP:

If you are from abroad

Registering for the first time in the UK

Date you came to live in the UK:

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

If you are returning from abroad

Previously been a resident in the UK

Date you left the UK:

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

Date you returned to the UK:

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

Carers

Do you have a carer?

Yes

No

Are you a carer for someone?

Yes

No

Name of carer:

Phone Number:

Address:

Do you give us permission to discuss your medical record with your carer?

Yes

No