Child Patient Registration

Everyone is welcome in general practice. You do not need to provide proof of ID, address, immigration status or an NHS number in order to receive care or see a GP.

To access our services, you will need to be registered as a patient with us. 

The registration process is quick and easy. Fill out the form and our admin team will process your registration.

If you are interested in registering, please check that you are within the catchment area of the practice.

Please check the catchment area before registering.

Emergency contact

  • Patient Details
  • Next of Kin
  • Additional info
  • Housing

Patient Details


First Name(s)

Date of Birth


Child's Main Address

Who has parental responsibility?

Someone else (please state name and relationship to child)

Mother's details

Mother's Name

Mother's Telephone

Mother's Address (if different from Child's)

Father's details

Father's Name

Father's Telephone

Father's Address (if different from Child's)

Next of Kin's details



Telephone (Home)

Telephone (Work)

Telephone (Mobile)

Additional info

If your child is under 1 years of age, were they premature?

Is your child home schooled?

If no, which school did they attend?

Names of previous school's (if any)

Has your child ever been suspended or excluded from school

Name of Health Visitor/ School Nurse (if known)

Has your child ever been subjected to a Child Protection Plan?

If yes, when?

Has your child ever been a


What type of housing does your child live in?

House or Flat (if flat which floor?)

Are there any housing problems (overcrowding, damp)?

Please list all the people that share the house with the child and their relationship to the child. If they are a child please state their age.