Online Registration

Please fill in your details and click Submit when complete.

Please only complete this registration form once. If you have previously submitted this form
at any time please do not do so again unless advised by the Medical Centre to do so.
Please do not use this form to update your address or other details.

Have you ever registered
with this practice before?
* Title:
Please enter your surname or family name
Please enter your first name
  If you don't know your NHS number it's very important that you fill in part 1 and 2 below
* Gender:  
 
* Do you identify as trans?
   
Please select your student Hall and enter your Flat/Room
or fill in your NEW HOME ADDRESS below:
Enter your own number. Preferably a UK mobile number.
Confirm your email address
* May we contact you using email?    
* May we contact you using SMS text?    
Confirm your email address
   
 
UK Emergency Contact 
 
Enter a person (full name including surname) we should contact in case of an emergency
Enter a phone number to the emergency contact
Enter your relationship to the emergency contact
Please help us trace your medical records by selecting if you are from UK or from
abroad (Part 1) and then filling in the next section (Part 2)
* Part 1. Select if you are from UK or abroad:
Part 2: Fill in if you come from the UK
(i.e. last address before moving here)




* Approximate Date of first living at this address:


Part 2: Fill in if you come from abroad
You can't register before you arrive in the UK
Have you lived or studied in the UK before?    
Supplementary Questions:
Please select one of the following options: More information...
Complete the following section if you come from another EEA country:
Do not complete this section if you have an EHIC issued by the UK.
Do you have a non-UK EHIC or PRC?   

(e.g. if you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state). Please give your S1 form to the practice staff. More information...
* Signature:
Please draw your unique signature in the box
   

College Information
* College:   
* College status:      

Health Questionnaire
 cm  kg
Physical Activities and Eating Habits:
* Ethnic origin:
   
Need interpreter:   
 
* Are you a carer? * Do you have a carer? * Do you have an advocate?
        
Please tick if you have, or have had, any of the following ILLNESSES:
 
 
* Do you SMOKE?

How often do you have a drink that contains ALCOHOL?
  A number of alcohol units per week 
NHS Alcohol Unit Calculator  
How many standard alcoholic drinks do you have on a typical day when you are drinking?
How often do you have 6 or more standard drinks on one occasion?
Do you have a Disability or Special Communication Needs?     
Please provide your preferred means of communication:
        
* Please note not all information is currently readily available *
 
VACCINATIONS
Have you had a Measles Mumps and Rubella vaccine (MMR)?      
Have you had a Meningitis ACW&Y vaccine?     
Have you had HPV VACCINATION?    
 
WOMEN OVER 25
Have you ever had a smear test?    
If you are over 25 and have not yet had a smear please make an appointment with the Practice Nurse.

* NHS Records
There are strict laws and regulations to ensure that your health records are kept confidential and can only be accessed by health professionals directly involved in your care. There is some sharing of information as detailed below. You can opt out of any of these at any time if you wish.
NHS Summary Care Record (SCR) - this is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had.  Having this information stored in one place makes it easier for healthcare staff to treat you in an emergency, or when your GP practice is closed:
  
NHS Records Amendment - Medical record sharing allows your medical record to be made available between your GP and other authorised health services involved in your care. You decide whether your medical record is shared out with other external health providers (e.g. hospitals, walk in centres) and whether your medical records from other health providers is shared with your GP. Your medical records are only accessed when it is necessary to provide services for you. Please indicate below your preference:
I wish for my medical record from external health providers to be shared with my GP:
  
I wish for my medical record to be shared with external health providers:
  

ONLINE SERVICES
The Health Centre offers online services for booking and cancelling appointments, ordering repeat medication, amending your
contact details and viewing your medical record.’ Initially, only booking and cancelling appointments will be available. You can apply
for the additional services by submitting the application form and personal identification documents as detailed on our website.
* Would you like to sign up for online services to book and cancel appointments?
  
We strongly recommend all our patients download the NHS App, where they will be able to access online services
as well as submit clinical and administrative queries: https://www.nhs.uk/using-the-nhs/nhs-services/the-nhs-app/

Patient/Practice Agreement for King's College Health Centre (please read this carefully)
We are committed to providing a warm welcome and excellent care to all patients in a calm and pleasant atmosphere. To this end, we propose the following agreement, which we hope will facilitate a good relationship between us and you.

The practice:

  • Aims to provide the highest quality of medical services possible, within the limits set by the NHS.
  • Will provide access to the practice doctors and nurses through a combination of electronic, video, booked face to face and telephone consultations, and walk-in triage clinics.
  • Will aim to consult with our patients for routine matters within two weeks. Consultations may be face to face, over the phone, or via e-consultations.
  • Expects practice staff to treat all patients in a courteous, caring and respectful manner regardless of age, ethnicity, disability, gender, sexual orientation, trans status, religion, belief and civil or family status.
  • Will attempt to attend to our patients needs as quickly as possible on arrival at the Health Centre.
  • Will provide a clean and safe environment for patients to wait and receive medical attention.
  • Will aim to keep to our appointment times. However, inevitably some medical problems do take longer than the allocated 10 minutes.
  • Will ensure that confidential medical information is protected and processed accordingly to latest NHS and data protection guidance.
  • Encourages patient feedback and should you wish to make a suggestion or complaint, we will provide information on how to do so, and will ensure that so doing does not compromise your medical care.
    If you feel we have fallen short in these commitments then please let us know by contacting the Practice Manager.

We ask you, the patient:

  • To attend appointments punctually and inform us as soon as possible (preferably at least 24 hours in advance) if you need to cancel your appointment. If you are late for your appointment, you may be asked to rebook.
  • To treat Health Centre staff and other patients with courtesy and respect at all times.
  • To respect the comfort and wellbeing of others by refraining from using personal audio equipment and be considerate when talking on mobile telephones whilst in the Health Centre. Smoking and the consumption of alcohol, intoxicating or illegal drugs is strictly forbidden. Animals, other than registered assistance dogs, may not be brought into the Health Centre.
  • To not bring bikes, scooters or skateboards into the Health Centre.

Additional notes:

The practice reserves the right to remove patients who break this agreement from our patient list. Should removal take place, the patient will be informed why this has been done. The practice has a zero tolerance policy for physical and verbal aggression towards our staff and other patients. Any patient using threatening language and/or behaviour will be removed from the list and may be reported to either the police or appropriate college authorities. Patients who persistently fail to attend appointments, or cancel them in good time, will be removed from our list. We may contact you by letter, telephone, email or text message as appropriate. Please let us know if you prefer not to be contacted by any of these methods.
If you are completing this form on behalf of someone else you must have explicit consent or power of attorney from that person.

By submitting this application you are agreeing to the terms as detailed above and wish to register for general medical services.

Organ Donation
The law has changed so that you need to opt out if you do not want to become a donor. It’s
important to talk to your family about your organ donation decision, as they will be asked to
support your decision. If you are undecided or do not want to become an organ donor, please
refer to the NHS Organ Donation website at www.organdonation.nhs.uk or 0300 123 23 23.
Blood Donation
If you are interested in becoming an blood donor, please click this link
to go to the blood donor registration page.
 
Please read our Privacy Notice.
The information you are submitting will be sent encrypted to the medical practice over the Internet, which still isn't 100% secure.
If you are worried about this you can instead obtain a form from the medical practice that can be filled in and delivered by hand.
* = Compulsory.
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