You should only send this form if you are sure that you are eligible to join this practice.
Sending this form will NOT automatically register you with the surgery.
Your details will be held at the surgery for a limited period of time. You are required to present in person to sign your registration form and provide proof of your address
Sending this form does NOT guarantee or even imply that you will be accepted onto the practice register
Confidentiality
By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy.
Also, by sending this form you are indicating your agreement that the surgery may contact you by email or telephone to discuss the information contained in this form.
If either of these points concerns you or you disagree in any way then you should use another method of notifying us of your change of contact details.
Personal Information
Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.
CORONAVIRUS (COVID-19) ADVICE
Do not leave home if you or someone you live with has either a high temperature or a new, continuous cough or loss/change to sense of smell or taste.