WHMP Adult Care Home Resident Registration Form

Fields marked "REQUIRED" are compulsory.. You should only send this form if you are sure that you are eligible to join this practice. Sending this form will NOT automatically register you with the surgery. Sending this form does NOT guarantee or even imply that you will be accepted onto the practice register.

Last Updated: 04/10/2023

Patient Details

Please help us trace your previous medical records by providing the following

Contact Details

Please be aware we may leave a standard voicemail for you on the numbers provided. No private details will be disclosed in any messages left.

Clinicians may use SMS messaging to communicate with you regarding health issues, please indicate below whether you are happy to receive these messages.

Registering for the first time from Abroad?

Registering Following Military Service?

Ethnic Origin and Main Language Spoken

Next of Kin / Emergency Contact Details

Your Health and Lifestyle

Smoking Status

Repeat Medication

If you are on any repeat medication, please submit an Engage Consult to speak to a GP or Clinical Pharmacist within six weeks of registering.

We are unable to prescribe repeat medication without an initial consultation. Please have a list of current medication with you during your consultation.

Do you currently have or have you ever suffered with any of the following:

For Women Only

Summary Care Record and Oxfordshire Care Summary

All patients registered with a GP have a Summary Care Record (SCR), unless they have chosen not to have one. The information held in your Summary Care Record gives health and care professionals, away from your usual GP practice, access to information to provide you with safer care, reduce the risk of prescribing errors and improve your patient experience.

Your Summary Care Record contains basic information about allergies and medications and any reactions that you have had to medication in the past.

Patient Online Access Registration

Patient Access allows you to view your live electronic medical record online and request repeat prescriptions. In order to access your patient details online, you will need to bring photographic ID and proof of address in to the practice.

Patient Disclaimer

The information provided above is correct to the best of my knowledge.

I have read and understood the information enclosed in the Patient Information Pack and have indicated my consent preferences throughout this form.

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