Page {{ paginatorProps.current }} of {{ }} ({{ paginatorProps.percentage }}% completed)

New Patient Registration Form (Child)

Before you complete this form, please have ready:

  1. Your childs birth certificate
  2. Your childs immunisation history
Patients Details

Information we need to register your child with the practice
Please note all fields marked with a * are mandatory for the registration

Please answer the following questions about your child:

Ethnicity and Religion
Medical History

If your child is on medication, please make an appointment to see the doctor when you have completed the registration. 

Immunisation History

Please select each immunisation your child has had, and provide us with details where possible.

Development Checks
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx

What happens to my child's information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your child's GP in order to provide continued healthcare and obtain treatment for them.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols.

To ensure the security of all patient information, all staff that have access to your child's records are covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold their records in strict confidence.

I certify that the information I have provided is correct and consent to my child's personal and medical information being used as stated above.

Privacy Consent

This form collects personal and medical information about your child. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.