Update registration details
The NHS is currently asking practices to ensure registration details are up to date. We would be grateful if you could complete this brief online form.
OPTIONAL: you can enter your height and weight if you wish, and update your contact details
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.
* Required
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Practice Name - OFFICE USE ONLY
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This review is only for patients registered at the practice below. Please do not alter
Your answer
Data Processing Notice
Participation
To participate in this online review you must confirm the following by ticking each box. If you are unable to do so please contact the practice
I am 18 years of age or older
I am currently located in the United Kingdom
I am a registered patient at the above named practice
I elect to participate in this online review in accordance with the Data Processing Notice above, which I have read and understood
First name
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Your answer
Surname
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Your answer
Month of birth
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Choose
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Day of birth
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Year of birth
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Choose
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Ethnicity
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This information is helpful because some ethnic groups are at higher risk of certain medical problems. Options are taken from the most recent UK census. If your ethnicity is not specified, you can enter it in 'Other', and if you would rather not say please select that option at the bottom of the list
White - British
White - Irish
White - any other white background
Mixed - white and black Caribbean
Mixed - white and Asian
Mixed - white and black African
Mixed - any other mixed background
Asian - Indian
Asian - Pakistani
Asian - Bangaldeshi
Asian - any other
Black - Caribbean
Black - African
Black - any other black background
Chinese
I would rather not say
Other:
Optional lifestyle questions
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These are helpful to ensure your medical record is up to date, and cover weight, height, smoking and alcohol use
I am happy to answer a few lifestyle questions
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