Online 'Pre-Registration' With The Practice

PreRegistrationIf you wish to pre-register with our practice, click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. When you visit the surgery for the first time you will be asked to sign the form to confirm that the details are correct.

PLEASE ENSURE THAT YOU COMPLETE EITHER THE ADULT OR CHILD FORM BELOW.

THERE ARE A TOTAL OF 3 FORMS TO BE COMPLETED TO FULLY REGISTER WITH OUR PRACTICE.

 WE CANNOT REGISTER YOU IF YOU DO NOT COMPLETE ALL OF THE FORMS.

Please also ensure that you include your NHS number.

Please complete forms 1, 2 and either 3a or 3b depending on the age of the person registering. See below.

1.PRE-REGISTRATION FORM

2.OPT OUT FORM

3a. ADULT REGISTRATION FORM

3b.CHILD REGISTRATION FORM (UNDER 16)

FORMS 2 AND 3a/3b WILL NEED TO BE EMAILED TO SOCCG.HILLLANESURGERY@NHS.NET

If you require the forms in a larger print, please find them below.


CHILD REGISTRATION FORM (UNDER 16) LARGE PRINT

ADULT REGISTRATION FORM - LARGE PRINT

When you register you will also be asked to fill out a medical questionnaire. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too, which you may fill out and send to us. When you come to the surgery you will be asked to sign this form to confirm that the details are correct.

Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.


Alternatively you may print off a registration form, fill it out and bring it in with you on your first visit to the practice.

pdfRegistration Form

 
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