Register as St Wulfstan Patient if you are over 16 including Out of Area | Webform Portal

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Registering with St Wulfstan Surgery if you are over 16 years old

Personal Details

Please provide as much information as you can and ensure that you complete all questions marked as "mandatory".You will receive a confirmation reference once your form has been successfully submitted. If you do not receive this, then please check that you have completed all mandatory fields and resubmit your form. Successfully submitted forms will be processed within 3 working days. We will only contact you if there is a problem with your registration.Please contact us if you would like to make an appointment to see the practice nurse (or doctor if you are on regular medication) for a new patient health check. This will ensure that our records are accurate and all routine checks to promote your health and well-being (such as blood pressure, smear tests, mammorgrams) are up-to-date.

Title *

First Name(s) *

Surname *

Previous Surname

Town and Country of Birth *

Home Address *

Landline Telephone number *

Mobile Telephone Number *

E-Mail address *

Date of Birth *

Current Age *

You have indicated that you are Under 16 years old. Please Use a different form to resgister as a patient. You can go to the form by clicking here

NHS Number if known

Previous address in the UK -help us to trace your medical records *

Previous GP *

Please tick if you are a veteran of the UK Armed Forces

yes No

If you are from abroad

Your first UK addresswhere you registered with a GP

If previously a resident of the UK, the date of leaving

Date you first came to live in the UK

If you are returning from the Armed Forces

Address before enlisting

Service or Personnel number

Enlistment date

NHS Organ Donation

On 20 May 2020, the law around organ donation in England was changed to allow more people to save more lives. For more information please visit https://www.organdonation.nhs.uk/

NHS Blood Donor Registration

To register please visit https://www.blood.co.uk/the-donation-process/registering-online/

Confirmation of Accuracy

Confirmation of Accuracy *

I confirm that the information I have given is to the best of my belief accurate

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Out-of-Area Patients

I am an out of area patient *

Are you an "Out of Area" patient? To find out, check here.

1. Are you already registered at St Wulfstan Surgery?

yes no

2. Is it practical for you to attend St Wulfstan Surgery as an Out-of-Area patient? You will not be eligible for home visits.

yes no

Is there anything else that you have not mentioned that you think it might be useful for us to know?

NHS Digital Data Sharing, Privacy Protection and the Summary Care Record

NHS Digital Data (formally the Health and Social Care Information Centre) collects information about the care you received from your GP and other healthcare providers with the purpose of aiding research and improving services. If you do not wish to have your data extracted by NHS Digital you can opt out by visiting http://www.nhs.uk/your-nhs-data-matters or ask a receptionist for details on how you can opt out by post.

My Summary Care Record Preferences. *

I do NOT wish to have a Summary Care Record I wish to have a Summary Care Record for medication and allergies and adverse reactions only I wish to have aSummary Care Record for medication and allergies and adverse reactions AND additional information

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

I consent to my information being used for the purposes described above and wish to submit this online form to St Wulfstan Surgery *

I agree

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted. All Information submitted through secure forms is encrypted and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy. This information does not leave the EEA. For the purposes of GDPR, St Wulfstan Surgery is the data controller and IPEGS is the data processor. Their privacy notices can be read at https://www.ipegs.co.uk/privacy-policy/

If you have previously been removed from the practice list your registration may not be processed.