Newborn Baby Registration

Please use this form to register your New Born Baby with our practice.

Please include their NHS number, which can be found in their red book.

Newborn Baby Registration

Newborn Baby Registration

Title:
Sex:
Please use date formatt DD/MM/YYYY
Please include postcode.

Ethnic Group

Please select the one which best describes the patient:
Is the first language English?

If you wish for your child to be registered with the Health Visiting Service, please visit the Children's Health Surrey Website: www.childrenshealthsurrey.nhs.uk/services/health-visiting-service.

Prescriptions

Please advise if you would like us to send your prescriptions via the Electronic Prescription Service (EPS), direct to a local pharmacy.

Summary Care Record

The new NHS Summary Care Record has been introduced to help deliver better and safer care and give you more choice about who you share your healthcare information with. The intention is to help clinicians in A & E Departments and ‘Out of Hours’ health services to give you safe, timely and effective treatment. Clinicians will only be allowed to access your record if they are authorised to do so and, even then, only if you give your express permission. You will be asked if healthcare staff can look at your Summary Care Record every time they need to, unless it is an emergency, for instance if you are unconscious. You can refuse if you think access is unnecessary.

Children under the age of 16

Patients under 16 years will have a Summary Care Record created for them unless their GP surgery is advised otherwise. If you are the parent or guardian of a child then please either make this information available to them or decide and act on their behalf.

Please choose one of the following options: *

Text Communication Consent

Patients registering with the practice are able to register for our text messaging service for the purposes of health promotion, practice news and for appointment reminders. Appointment reminders by text are an additional service and the responsibility for attending appointments or cancelling them rests with the patient (or patient representative).

The text message facility can be cancelled at any time by contacting the practice in writing.

Text messages are generated using a secure facility over a public network onto a personal  telephone and as such may not be secure, however the practice will not transmit any information which would enable an individual patient to be identified.

If more than one person shares the use of the mobile phone number detailed below, we will need a
consent form from each of those people.

Declaration

Thank you for completing this form.

By signing below you are signing to register your new baby as a patient.

You are signing to say that the information provided within this form is correct and true to the best of your knowledge and if any details should change, it is the responsibility of the patient (or patient
representative) to let the surgery know as soon as possible.

I am: *