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New Patient Registration

Thank you for joining the practice. It often takes several weeks for your records to reach us from your previous doctor. So, to ensure that we have up to date medical and personal details, please complete the registration form below as fully as possible.

When you register with us, we are contractually obliged to assign you with a named GP. However please note, that regardless of who your assigned named GP is, you are always free to see the clinician of your choice.

Registrations may be rejected if you are living outside our Practice boundary. Please contact the registration team if you are unsure on (017683) 71369.

The information you give us is confidential and is subject to the Data Protection Act.

1New Patient Registration

Telephone Numbers, please include area code

Please help us trace your medical records by providing the following information.

2If you are from abroad

3If you are returning from the Armed Forces

4If you are registering a child under 5

5If you need your doctor to dispense medicines and appliances*

* Not all doctors are authorised to dispense medicines

6NHS Organ Donor Registration

I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death.

For more information, please ask at reception for an information leaflet or visit https://www.organdonation.nhs.uk or call 0300 123 23 23

7Next of Kin / Emergency Contact

Telephone Numbers, please include area code

2nd Next of Kin

Telephone Numbers, please include area code

8Care Record

Your Summary Care Record (SCR) is a short summary of your GP medical records. It tells other health and care staff that care for you about the medicines you take and your allergies. This means they can give you better care if you need health care away from your usual doctor's surgery e.g. in an emergency, when you're on holiday, when your surgery is closed, at out-patient clinics or when you visit a pharmacy

9Special Circumstances

10Carers Register

11For Children Up To 16 Years

Does your child have contact with any of the following?

12Health and Lifestyle

13Past Medical History


Privacy Protection

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 secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

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.


Your Neighbourhood Professionals. Just a Click Away! Looking for residential or nursing care? Wanting a home from home? Then check out your local options and book a visit/tour today
Silver Street, Kirkby Stephen, Cumbria, CA17 4RB
  • Telephone (017683) 71369
Website supplied by Oldroyd Publishing Group
Your Neighbourhood Professionals. Just a Click Away! Looking for residential or nursing care? Wanting a home from home? Then check out your local options and book a visit/tour today
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