New Patient Registration form

Summary Care Record (SRC)

Please read this section very carefully before selecting your choice below
These are strict laws and regulations to ensure that your health records are kept confidential and can only be accessed by health professionals directly involved in your care. There is some sharing of information as detailed below. You can opt out of any of these at any time if you wish.

If you are registered with a GP practice in England you will have a Summary Care Record (SCR), unless you have previously chosen not to have one. It includes important information about your health, such as;
- Medicines you are taking
- Allergies you suffer from
- Any bad reactions to medicines
Below are also included (if available) in the "additional information" part of your Summary Care Record to enhance the care you receive:
- Your illnesses and health problems
- Operations and vaccinations you have had in the past
- How you would like to be treated - such as where you would prefer to receive care
- What support you might need
- Who should be contacted for more information about you
The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently. NHS Summary Care Records (SCR)

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

Please see CLICK HERE for more information about SCR from NHS Digital
Do you agree to opt in to this service?:*

Yes – I would like a Summary Care Record and express consent for medication, allergies, adverse reactions and additional informationYes – I would like a Summary Care Record and express consent for medication, allergies and adverse reactions onlyNo – I would not like a Summary Care Record and express dissent for Summary Care Record (opt out)
NHS Organ Donor Registration
For more information on organ donation please visit: www.organdonation.nhs.uk
NHS Blood Donor Registration
If you would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood, please visit their website on: www.blood.co.uk or call direct on 03001232323
What happens to my information
Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.
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Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.
I consent to the practice collecting and storing my data from this form:*

Yes
Please verify that you are human*

Understanding of Practice Registration Policy
1. Always contact the Practice to let us know if you cannot attend for an appointment. This can be done by telephone or on the NHS App. Failure to do so may stop someone else, who needs an appointment being seen. If you fail to attend three appointments within 12 months, you may be removed from the practice register.
2. All non-NHS services will incur a charge depending upon the service requested. 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. Visa Letters. It is not our policy to give visa letters to patients.
6. If you change any of your personal details, please inform us immediately. If you move out of the catchment area you will need to change to another G.P. practice.
7. Two working days' notice is required for repeat prescriptions.
8. Only one problem per appointment, should you have more than one problem to discuss then please make one appointment for each.
I agree to inform the practice should I seek alternative health care from a private provider. This is to ensure my continuity of care.*

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