New Patient Agreement

Please confirm you accept the following conditions of registration.

Last Updated: 09/10/2024

Your details

Please provide the following details so we can match this form to your application for registration.

Your full name *

Your date of birth *

Your NHS number (if known)

Date you submitted your application to register *

Home Visits

The practice does not routinely offer home visits except for housebound patients or in exceptional circumstances. Any visit is at the clinical discretion of a doctor or nurse.

Please confirm you accept the practice policy about home visits. *

Yes No

Controlled Drugs

The practice will not routinely prescribe the following medications unless there are exceptional circumstances. An appointment will be required with a doctor or nurse to discuss the clinical need for any of these medications.

Diazepam
Dihydrocodeine
Morphine
Nitrazepam
Oxycodone
Pregabalin
Temazepam
Tramadol
Zopiclone

Please confirm you accept the practice policy about controlled drugs. *

Yes No

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New Patient Agreement

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