New Patient Registration (child under 16)

If you would like to register with the practice please use this form.

To register a new patient you will need to live within our practice boundary, however since January 2015 all GP practices have been free to register new patients who live outside their practice area without any obligation on the practice to provide home visits for such patients when the patient is at home, away from, and unable to attend, their registered practice.

New Patient Registration - Child under 16

The lawful and proper treatment of personal information by the practice is extremely important to the success of our business and in order to maintain the confidence of our services to you, the patient. Please note the surgery uses a ‘Call board’ to direct patients to their appointment.

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Gender *
Any responses we send will go to this email address.
What is your preferred contact number? *
Can we contact you by text?
Can we contact you by email?
Can we leave you voicemail messages?

Parental Responsibility and Next of Kin

A child who is being looked after by their local authority is known as a child in care. They might be living: with foster parents, at home with their parents under the supervision of social services or in residential children's homes.

Is the child a looked after child? *
If Yes under what arrangement:
Parental Responsibility

Ethnicity

Please specify the child's ethnic group:
Do you need an interpreter? *

Previous Details

Does the child have a previous UK address? *
Is the child currently registered with another GP? *
Please include postcode.

If the child is from abroad

Registering with the NHS for the first time in the UK
Please use this date format: DD/MM/YYYY.

If the child is returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Carers

A carer is a friend or family member who gives their time to support a person in their home, to an extent that the person could not remain at home if this care was not being provided. A carer can receive Carers Allowance, but not a wage and the care they are giving will significantly affect their own life.

Does the child look after or support someone who couldn’t manage without them?
Do they look after someone who is a patient of Market Harborough and Bosworth Partnership?
Are they a: