Child Patient Registration
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
Surname
First Name(s)
Date of Birth
Gender
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
Name
Address
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
Housing
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.
Some required Fields are empty
Please check the highlighted fields.
Please check the highlighted fields.