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Patient Forms

Please find below various patient forms that can be printed off:

Consent to Share Confidential Information with a Third Party

The Data Protection Act 2018 and the ethical codes of conduct of all health care professionals require that medical data be treated with great respect for confidentiality. We are not permitted to share any medical details with a third party without your consent. If you wish to give a Carer or third party consent then please print and complete the form below, this can be brought into surgery for your records to be updated.

Consent to Share Confidential Information with a Third Party

Online Access

Under 11yrs old

Parents can have full proxy access up to 11yrs old to all services. When the child reaches the age of 11 it will be restricted to only online appointments, repeat prescription requests and summary care record. To Register for online services for a child under 11yrs old please complete the following form:

Patient Online under 11yr registration form

11 – 16yr old

Restricted proxy access to online appointments and repeat prescriptions only. If parents are requesting additional access rights then the child would need to be assessed for competency. The child can have their own access or grant proxy access to parents if there are deemed competent by the GP (taking into consideration coercion and understanding this will be in place until they turn 16yr old or they request removal of services). This will be assessed on a Case by Case basis. When the child reaches 16yrs old the proxy access will be switch off and the child should be given their own access which should be applied for using the over 16yrs form.

Proxy Access form to be completed by both parent and Child, and both must present with completed form and ID. To request access for your child who is aged 11-16yrs of age please complete the following form:

Patient Online Proxy consent form

Over 16yrs old

Own access unless patient lack capacity as determined by the GP. All patients over the age of 16yr should complete the following form to request access to online services.

Patient Online registration form

Patient Online Proxy consent form

New Patient Registration Forms

Select the following link for further information: New Patients page

Registration Form

New Patient Questionnaire - Adult

New Patient Questionnaire - Child

New Patient Questionnaire - Newborn Child

Change of Address or Name

The following form can be printed off to be completed and handed in at reception so we can update your record. Alternatively, please request a copy from reception.

Change of Address/Name

Local Services, Let