Registration form for child or young person

Fields marked "REQUIRED" are compulsory. You should only send this form if you are sure that you are eligible to join this Practice and that you live within our Practice boundary. Sending this form does NOT guarantee or imply that you will be accepted onto the Practice register. Please allow up to five working days for us to process your registration.

Last Updated: 13/05/2022

Details of child being registered

Details of Childs Main Carer

Does the child have contact with the father

Other Information

Communication Needs

The Accessible Information Standard aims to ensure patients and/or their carers who have a disability or sensory loss can receive, access and understand information in a suitable format e.g. large print, braille, email or from a British Sign Language interpreter. Individuals most likely to be affected by the Standard are those who have sight and/or hearing loss and people with a learning disability (this list is not exhaustive)


The SCR was introduced many years ago to help deliver better and safer healthcare. It contains basic information about and allergies you may have, unexpected reactions to medications and any prescriptions you have recently received. The intention is to allow Hospital A&E departments and Out of Hours health services to give you safe, timely and effective treatment. Over time, health professionals treating you may add details about your health to the SCR with your consent.

Sharing Your Health Record

With the development of information technology, the NHS will increasingly be sharing key information from your GP Medical Record with Out of Hours GP Services, Hospital A&E Units, Community Hospitals, Community Nurses, all of who may be looking after you at various points in your life. Sharing your information can improve the quality and safety of care you receive and in some cases can be vital in making life-saving decisions about your treatment.


This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.