New patient registration additional details March 2025 v2

PLEASE NOTE YOU MUST ALSO COMPLETE THE NEW PATIENT REGISTRATION FORM OTHERWISE WE CANNOT REGISTER YOU

Last Updated: 24/03/2025

  • Personal Details

    Please complete the following sections

    Title (optional)
    Date of Birth (optional)
    For example, 15 3 1984
    How would you describe your sexual orientation ? (optional)

  • Family History: please select if close blood relatives have had any of the following

    Family medical hisory

    Please select if close blood relatives have had any of the following (optional)

  • Blood pressure

  • Women's Health

    Date of most recent smear (optional)
    For example, 15 3 1984
    If age 50 -65, date of last mammogram (optional)
    For example, 15 3 1984
    Are you pregnant (optional)
    If pregnant, date of last period (optional)
    For example, 15 3 1984

  • Patient Participation Group

    St Peters has an active patient participation group which meets several times a year to work with the Practice to improve our services. This is also a good place to come to learn about plans for new developments. We particularly encourage younger people and people with long term conditions to get involved to help us make our practice accessible to all. Do you wish to join the Patient Participation Group (optional)

  • How the NHS will share your data

    The following questions allow you to tell us how you would like St Peter’s Health Centre to share your medical records with other NHS organisations involved in your care. If you leave any question unanswered, we will not make any changes to your record. Any previous sharing preferences you have given will remain in place. If you have not expressed a preference previously, the default options will be applied.

     

    Please note that the practice also sends anonymous data to Public Health England for the early warning and monitoring of public health and seasonal outbreaks of diseases such as influenza, and to aid response to incidents where the health of the population is at risk.

    Do you consent to St Peter’s Health Centre sharing your medical records with other NHS organisations caring for you, for the purposes of healthcare? This is known as sharing out. Default setting: No (optional)
    Do you consent to St Peter’s Health Centre viewing the medical records shared by other NHS organisations caring for you, for the purposes of healthcare? This is known as sharing in. Default setting: No (optional)
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