Temporary Registration With Our Care Home Assessment Team


Complete this form for a patient living in a care home to temporarily join our surgery and our Care Home Assessment Team.

You must complete one form per person. 

Last Updated: 14/05/2024

Patient's Details

Nominate a Pharmacy

Our prescriptions are now signed, sent and processed electronically. Prescriptions are sent electronically to your nominated pharmacy.

You will need to nominate a pharmacy.

Use the NHS 'Find a Pharmacy' tool to choose your preferred pharmacy:

Find a pharmacy - NHS (www.nhs.uk)

NHS Organ Donor

All adults in England are now considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the excluded groups.

If you would like to opt-out or to learn more please visit:





Our Privacy Notice, Data Sharing Policy and Options

Before completing this section, please read our Privacy Notice and Data Sharing Policy. These give you more information on:

  • The data we hold on you
  • What we do with your data
  • Who we share your data with
  • Your rights under General Data Protection Regulation (GDPR)

You can view the Privacy Notice and Data Sharing Policy on our website:




By submitting your data online via our encrypted process, you are giving us permission to register you as a patient. We only use your information to set you up as a new patient. Once your application is complete, a PDF version will be added to your notes and the form deleted from our online contact form system.

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