Please ensure you:

  • Attach GMS1 form 

  • Attach Proof of identity 

  • Fill out immunisation history form (if applicable)

GMS1 Form (Required)

Please fill out the following document and fill out the details. (You are able to type in to the PDF).

Please save as and attach below.

Upload File
Click above for GMS1 form

Personal Identification (Required)

Please upload a form of personal identification. Such as your passport or drivers license. 

Upload File

Medical Questionnaire - Section 1: Child Details

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Medical Questionnaire - Section 2.1: Ethnicity

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Medical Questionnaire - Section 2.2: Medical History

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Medical Questionnaire - Section 2.3: Family History

Family History - Tick if you have any first degree family members who have been diagnosed with the following:

Medical Questionnaire - Section 3: Immunisation History 

Please fill out the following document regarding the child immunisation history. It is essential you do this to ensure we have an up to date vaccination record for your child. 

Please save the document & attach below. 

Click above for the immunisation history form 
Upload File

Medical Questionnaire - Section 4: Electronic Prescription Service

The Electronic Prescription Service (EPS) is an NHS service. It gives you the chance to change how your GP sends your prescription to the place you choose to get your medicines or appliances from. If you want to use EPS ask someone at your GP surgery or at any pharmacy or dispensing appliance contractor that offers EPS to add your nomination for you. Nomination means you choose a place for your GP practice to electronically send your prescription to. You don't need a computer to use EPS. For more information, please visit our website.  

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If you have ticked yes for the Electronic Prescription Service & the nomination above is left blank, we will automatically nominate you to the closest pharmacy to your address.  

Medical Questionnaire - Section 5: Online Access

At Carepoint Practice, we aim to offer everyone in our care a high quality service and therefore we have made patient access available to all our patients.  This is available through the Patient.info website and as a mobile app for both Android and iOS devices, 

 
With Patient Access, you can now access our services (mentioned below) at home, work or on the move — wherever you can connect to the internet. What's more, because Patient Access is a 24 hour online service you can do this in your own time, day or night. 

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  • Book an appointment. 

  • Order repeat prescriptions. 

  • Change your address details. 

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If you have selected yes, you will be texted an online linkage key within 10 working days of you registering. If you have not received the text, please call reception. 

 
Children under 11 are able to have a parent/carer as a proxy user. Patients 11-18 are required to fill out a separate authorisation form.

Medical Questionnaire - Section 6: Out of Area

If you live more than 1km away from our practice postcode, please be aware that we will no longer be able to visit you if you are unable to attend the practice. This may make it more difficult for you to access medical help when you are not well. It is not the responsibility of the practice to arrange for another doctor to visit you in these circumstances.  

 

Should you still wish to remain registered at the practice under these terms then please complete the section below (child’s questionnaire can be completed by parents) 

 

I wish to remain registered at the practice and accept that I will not be able to ask for a home visit at my address and that the practice will not be responsible for arranging this help for me if required 

Medical Questionnaire - Section 7: Summary Care Records

Request for all clinical data to be withheld from the summary care record 

 

What does it mean if I DO NOT have a summary care record? 

 

Health-care staff treating you may not be aware of your current medications in order to treat you safely and effectively. Health-care staff treating you may not be made aware of current conditions and/or diagnoses leading to a delay or missed opportunity for correct treatment. Health-care staff may not be aware of any allergies/adverse reactions to medications and may prescribe or administer a drug/treatment with adverse consequences.  

 

Questions 

If you have any questions or if you wish to discuss your choices or concerns, please telephone the NHS Care Records Service Information Line on 0845 603 8510. If you remain unsure about whether or not to have a SCR please speak to reception. 

 

I DO NOT want to share my clinical data 

Please go to www.nhs.uk/your-nhs-data-matters to opt out. The GP practice can no longer opt you out. 

Medical Questionnaire - Section 8: National Patient Date Opt-Out

Please go to www.nhs.uk/your-nhs-data-matters for information regarding the National Patient Data Opt-Out. You can also update your preferences on the NHS website (you will need your name, date of birth & NHS Number). The GP practice can no longer opt you out.  

Thank you for submitting the online registration for Carepoint Practice. It may take us up to 5 working days to register you. If you have not heard from us by then, please call us.

Carepoint Practice Online Registration Form

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