Child New Patient Registration

Please complete the form below for each person that is registering at the practice.

* = Mandatory field

Child New Patient Registration
Please use this date format: DD/MM/YYYY.

Previous Details

Next of Kin and Contact Details - At least one parent/carer/guardian must be registered at the practice

We will use these contact details to send reminders about appointments, reviews and other services which may be of benefit in your child's care.

We will not leave detailed messages on your phone but may ask you to contact us or leave a simple message if we do not need to speak to you.


Record Sharing

Thank you. This information will be shared with The Primary Health Care Team

Systm One Sharing

Summary Care Record


Electronic Prescription Service (EPS)

The Electronic Prescription Service (EPS) is a NHS service that allows us to send your prescription(s) directly to your chosen pharmacy. This paper-free prescription service means that you do not have to come into the surgery to collect your prescription. We encourage all patients to register for this free service.

EPS Registration

I would like to have my prescription sent electronically.
Not sure what your closest pharmacy is?

Use the NHS Find a Pharmacy tool.


Ethnicity and Religion

Having information about patients’ ethnic groups would be helpful for the NHS so that it can plan and provide culturally appropriate and better services to meet patients’ needs. If you do not wish to provide this information you do not have to do so.