New patient registration
This form allows you to submit some basic health information and contact details to the practice as part of your registration process. Your answers will be added to your medical record. This may take 20-30 minutes.
You can enter your height, weight and blood pressure readings, and fill out a medication review (if relevant).
It will be helpful to know your
- NHS number (England & Wales)
- CHI number (Scotland)
- Health & Care number (N Ireland)
These are commonly found on NHS letters and prescriptions. In England and Wales you can check
BLOOD PRESSURE (optional): If you regularly monitor your blood pressure, you can submit recent readings here. Ideally measure your blood pressure in the morning and in the evening, each time taking two readings while sat down, 1 minute apart. Continue measurements twice daily for at least 4 days and ideally for 7. If you want to submit your readings it works best to collect them all before completing this form.
SAFETY: Your answers will be attached to your medical record but may not be seen immediately. This system should never be used if you are in need of urgent medical attention. In this event, please contact the appropriate services (999 or 111) or the practice as normal.
Sign in to Google
to save your progress.
If text is too small on your device, turn it sideways. You can also type the link you received into a tablet or computer browser to view on a larger screen
Practice Name - OFFICE USE ONLY
This review is only for patients registered at the practice below. Please do not alter
Data Processing Notice
Who is this for?
Please note that anyone under 18 can only have this form completed by a parent or legal guardian on their behalf
I am completing this for myself
I am completing this for my child
Never submit passwords through Google Forms.
This form was created inside of MedLink Solutions Ltd.