New-born 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.

Has the child been registered
with the NHS before?
Please enter your first name
 
* Child's gender:    
Please fill in child's HOME ADDRESS in Exeter:
 
Parent or Guardian details
Parent or Guardian address
if different from above:

(including postcode)
*
A confirmation message will be sent to this address.
Confirm your email address
It is your responsibility to keep the practice updated with any changes in your telephone number, email and postal address.
We may contact you with appointment details, test results or health campaigns or Patient Participation Group details.
* May we contact you using email?    
* May we contact you using SMS text?    
* May we contact you by letter?    
* May we contact you by phone call?    
   
 
* Attach a copy of your baby ID:
(Baby Birth Certificate)
 
I confirm that the information I have provided is true to the best of my knowledge
* Parent/Guardian signature:
Please draw your unique signature in the box
   
Health Questionnaire
Please record any significant FAMILY HISTORY of close relatives with medical problems:
 
 

Electronic Prescribing
If you would like your child's prescriptions to be sent electronically, please provide details of the pharmacy you would like to use:
   
 
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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