• New Patient Registration Form

  • Welcome to The Private GP Clinic Sevenoaks

    Dr Bartlett and the team are delighted to welcome you to our practice. We pride ourselves on delivering truly exceptional, personalised care for you and your family.

    To help us complete your registration, please take a few moments to fill in this short form. Once submitted, our team will take care of the rest.

     
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  • New Patient Registration Details

  • Date of Birth*
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    2 digit day, 2 digit month, 4 digit year
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  • Next of Kin Contact Details

  • Allergies

  • Coordinating your care with your NHS GP

  • We aim to provide truly exceptional care to all our valued patients.

    To help us help you, we kindly ask all new patients to take note of our Clinic's terms and conditions:

    I understand that all appointments are secured by payment in advance of the appointment, which can be taken over the telephone or via a secure payment link sent by email. If payment is not made, a £50 surcharge will be added to my account after three unsuccessful attempts to contact me regarding the outstanding payment. Additionally, a £50 surcharge will be applied each month until the invoice is settled. A full list of our fees is available in the registration pack and on our website.

    I understand the cancellation policy, i.e. appointments cancelled with less than 24 hours’ notice and appointments missed without notice will be charged the full appointment fee.

    I understand and acknowledge that vaccine appointments are non-refundable once booked. However, appointment times may be changed, subject to availability, as vaccines are ordered individually for each patient on a named-patient basis from our suppliers.

    I understand that refunds are available under specific conditions and must be requested within 3 months, except in exceptional circumstances. Refunds will be processed to the original payment account or credited for future appointments. Exceptions apply for medical or personal emergencies with proof required. The full refund policy is available upon request. Membership fees are non-refundable.

    I understand that I am responsible for the settlement of all charges made by The Private GP Clinic in connection with my investigations and treatment.  I will be given a receipt for all amounts paid and I can use these to reclaim from my insurance company if appropriate.

    I understand that all patient data is held in accordance with the Data Protection Act 1998. If I require access to my files I must make a request in writing. I understand that this may incur a charge.  

     

    I have read the above terms and conditions and accept them.

     

     

  • Patient Third Party Consent

    With your permission, we may contact your NHS GP practice to access relevant medical information. This helps us build a fuller picture of your health, so we can provide safer, more personalised care rather than relying only on the information available during your appointment. I consent and give my permission for the staff at The Private GP Clinic Sevenoaks to have full access to my medical records, including pathology and imaging test results and to release any part of my medical records.
  • Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • AI-Assisted medical notetaking in your consultation

    How it works: The software listens to the consultation and generates a draft medical note for the clinician. Your doctor will review, edit and approve the note before it becomes part of your medical record.The system does not make clinical decisions and does not replace your clinician.Using this software is completely optional, but we recommend it as it can help expedite any ongoing care that may be required following your consultation, such as a referral to a consultant.
  • Consent to the use of AI-Assisted notetaking*
  • Medical History

  • Do you smoke or vape?
  • Please tick if you suffer from or have ever suffered from any of the following:
  • For female patients only: Have you ever had a cervical smear?
  • Have you ever had a mammogram or breast cancer screening?
  • Should be Empty: