Register Online

Registration

Countesthorpe Health Centre is currently able to take on new patients who live within the practice area – see area map.

If you wish to register you have 2 options:

Call in during surgery hours and pick up a form. You can either complete this at the time or take it away with you and drop it in later.
You can complete the online registration form.

You will need your NHS number and those of any family members wishing to register. If you do not have these written down, the easiest way to obtain your number is to telephone your previous GP practice.

If you need to see a doctor urgently before you have registered you can still make an appointment and then complete your registration when you come to the surgery.

New patient check

As a new patient to the practice we will invite you to make an appointment to see a Healthcare Assistant for a New Patient Check. This will allow us to gather information about your healthcare needs as soon as possible. It can take around six to eight weeks for your full medical records to be transferred from your previous practice. If you are on any repeat medication you will also need to make an appointment with a doctor who will set up the medication so that in future you can order via our repeat prescription service. If you have a prescription re-order form from your previous practice please bring this with you. Alternatively you could bring the packaging from your current medication.

Registration

Part 1 - Complete this online form for each family member.

Part 2 - If you wish to Become a Donor, print and sign this form or register online at www.uktransplant.org.uk or call 0845 60 60 400

Part 3 - General Health Questions. Please print this form, complete it and bring it with you to your new patient check

Part 4 - Alcohol Questionnaire. Please print this form, complete it and bring it with you to your new patient check

New Patient Online Registration Form

Please complete the form with all your details.
(* Denotes required fields).

* E-mail Address:

* Title:

* Surame:

* Full Names:

Previous Surname:

* Date of Birth:

Your NHS Number is typically 10 digits often shown in the format: XXX XXX XXXX

* NHS Number:

*Sex:

* Town of Birth:

* Country of Birth:

* Home Address:

* Postcode:

* Telephone:

* What is your first Langauge:

* What is your ethnic group:

Choose only one from A to E below, then select the appropriate option to indicate your ethnic group from the dropdown menu.

A. White:

B. Mixed:

C. Asian / Asian British:

D. Black / Black British:

E. Chinese / other ethnic group:

Please describe your ethnic group:

Please help us trace your previous medical records by providing the following information:

Your previous address in the UK:

Name of previous doctor:

Address of previous doctor:

If you are from abroad:

Your first UK address where registered with a GP:

If previously resident in the UK, date of leaving:

Date you first came to live in the UK:

If you are returning from the Armed Forces:

Address before enlisting:

Service or personnel number:

Enlistment date:

Would you like your doctor to dispense medicines to you:

(This only applies if you live more than 1 mile from the nearest chemist and are in a rural location. The surgery will advise you if this applies to your address.)