nhs
How Do I... Register With The Practice?

To register as a new patient online please complete the form below making sure you FULLY COMPLETE both the NHS Family Doctor Services Registration Form and the New Patient Questionnaire that follows it. If you do not complete both of these forms fully we will be unable to register you with the practice. To complete your registration you will need to visit the surgery with two documents confirming your proof of your identity: one photo, eg driving licence or passport, and one confirming your address, eg utility bill.

Please be aware that if you have any ongoing medical conditions or take any regular medication then you will need to book an appointment to see the practice nurse for a new patient health check. Please allow two working days after submission of your online registration form before booking this appointment to ensure that you are on our system.

Greenyard Healthcare
Waltham Abbey Health Centre
1st Floor
Sewardstone Road
Watham Abbey, Essex, EN9 1NP

Tel: 01992 714088
Fax: 01992 763866

PATIENT DETAILS
Surname:
Date of Birth:
First names:
NHS No: - -
Previous Surname:
  Town & Country of Birth:
Smoker
Ethnic Origin:
  
Email Address: (your-email@address.co.uk)
Home Address:  
Postcode:
Telephone:
Mobile:
Current Medication: Past Medical History:
Vaccinations:
PREVIOUS MEDICAL RECORDS
Your previous address in UK Previous GP Details
Postcode:
Name of previous doctor while at that address:
Address of that doctor:
Postcode:
ARE YOU FROM ABROAD?

ARE YOU RETURNING FROM THE ARMED FORCES?

If you need your doctor to dispense medicines and appliances*
I live more than 1 mile in a straight line from the nearest chemist -
I would have serious difficulty in getting them from a chemist -
*not all doctors are authorised to dispense medicines
NHS Organ Donor Registration
I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my death.
Please check as appropriate:-
Heart Liver Corneas
Lungs Pancreas Any part of my body
Sending this form does not guarantee or even imply that you will be accepted onto the practice register.
CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of this data is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above
Click 'Submit' to send your details to the surgery, you will then be prompted to complete a New Patient Questionnaire form.
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