Welcome to Knightwick Surgery
On this page are all the forms you need to
register with us, as well as information to help you make the best use of our services.
PLEASE ENSURE YOU PRINT AND COMPLETE ALL FORMS
NUMBERED 1 TO 5 BELOW
(CHILDREN UNDER 15 REQUIRE ONLY FORM 1 TO BE COMPLETED)
Please return completed forms to Reception.
We require photo ID and proof of address before we can register you.
Patients over 15 years need to be present with their ID at time of registration.
1. Registration form – this is needed to register you as a patient and allows us to transfer your medical notes from your previous Practice.
1. Registration Form
2. New Patient Health Check Questionnaire – this will provide us with information we can use until we receive your notes. You will be invited for a new patient health check where appropriate.
2. New Patient Health Questionnaire
3. Medication Collection form – please complete this if you will require other people to collect your medication.
3. Medication Collection form
4. Patient Online Access registration form – please complete the form below for online access to your medical records and to enable you to book appointments and order repeat medication online. This gives you access to view limited parts of your record which includes medication, allergies and adverse reactions.
It will also allow you to contact the GP for advice when you do not need a face-to-face appointment.
If you require access to view other parts of your record, such as test requests, please contact Reception.
Please note we are now able to offer proxy access for children and dependants. Please contact the surgery for further information.
4. Online Access Request form Online Access information
5. Summary Care Record (SCR) opt out form - you will need to fill this out to let us know if you wish to have a Summary Care Record created for you or not (see link 10 on right for more information about the SCR)
5. Summary Care Record Consent Form