Child New Patient Registration

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

To register a new patient you will need to live within our practice boundary.

Child New Patient Registration

Child New Patient Registration

Patient Details

Title:

Previous Details

Please include postcode.
Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK.
Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Parent Details

Please include their full name, date of birth, and relationship to the child.
Does the child have an allocated social worker?
Is the child fostered?
Are they a Looked after Child?

School/Child Care Details

Nursery

School

Ethnicity

Please specify the ethnic group you consider you belong to: *
Do you require an interpreter?

Medical History

Is your child allergic to anything? *

Child Immunisations

If your child is 0-5 years old, please kindly provide us with the information about your child immunisations that they have received. If you are unsure which vaccinations you child has had it would be helpful if you can bring along any records you have in your RED Child Health Book when you next come to the Practice.

Please provide date given and where this was completed.
Please provide date given and where this was completed.
Please provide date given and where this was completed.
Please provide date given and where this was completed.
Please provide date given and where this was completed.
Please provide date given and where this was completed.
Are there any vaccinations you don’t want your child to have?

If you would like to discuss any of the vaccinations please ask the reception team to help you ask the Nursing Team or visit the NHS website: www.nhs.uk.

Summary Care Records

These are electronic records of your childs medications / allergies that can be accessed (with your consent only) in the event of an Emergency ( for example at an A & E Department) If you wish to opt out of having the SCR, please ask or complete our online Summary Care Record Opt Out form.