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

Were you ever registered with an Armed Forces GP

Footnote: These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.

Please tell your family you want to be an organ donor. If you do not want to be an organ donor, please visit www.organdonation.nhs.ul or call 0300 123 23 23 to register your decision.

All blood types are needed, especially O negative and B negative. Visit www.blood.co.uk or call 0300 123 23 23.

NOTE: For students, current address is your term-time address.

NOTE: For students, previous address is your home address (outside of university).

Cervical screening is available to women and people with a cervix aged 25 to 64 years.

• 1 pint of beer/lager/cider (ABV 3.6%) = 2 units
• 1 small measure (25ml) of spirits = 1 unit
• A small glass (125ml) of wine = 1.5 units

Does anyone in your family have any of the following medical conditions?

Summary Care Records imporve the safety and quality of patient care. Because the Summary Care Record is an electronic record it will give healthcare staff faster, easier access to essential information about you. This helps provide you with safe treatment when you need care in an emergency or when the GP practice is closed. Essential information is medication, adverse reactions and allergies only.

If you have answered no, please contact our reception for an opt-out form.

1. All non NHS services will incur a charge depending upon the service requested. Please confirm current fees with the receptionist.

2. All photocopies requested by patients will be charged. Please confirm current fees with the receptionist.

3. Housing letters. It is not our policy to give housing letters to patients.

4. Bank letters. It is not our policy to give Bank letters to patients.

5. If you change address, landline telephone number, mobile telephone number or e-mail address, please tell us straight away as you may have moved out of the Practice area. If you move out of the area you may need to change to another G.P.

6. Forty-eight hours notice is required for repeat prescriptions.

7. Only one appointment per patient and only one item per appointment. If other members of the family need to see the Doctor, please make another appointment.

8. Always telephone the Practice to let us know if you cannot attend for an appointment. Failure to do so may stop someone else, who needs to be seen urgently, being seen. Please note if you are more than ten minutes late this will be classed as a “did not attend” (DNA) and the clinician will not be able to see you. If you fail to attend three appointments within 12 months you may be removed from the practice register.

9. I agree to inform the practice should I seek alternative health care from a private provider. This is to ensure my continuity of care.

I AGREE TO THE ABOVE TERMS AND CONDITIONS OF MY REGISTRATION AT NEWCASTLE MEDICAL CENTRE