Welcome to Knightwick Surgery
In this pack you will find all the forms you need to
register with us as well as information to help you make the best use of our services.
PLEASE ENSURE YOU COMPLETE ALL FORMS NUMBERED 1 TO 5 BELOW
(CHILDREN UNDER 15 REQUIRE ONLY FORM 1 TO BE COMPLETED)
Registration form – this is needed to register you as a patient and allows us to transfer your medical notes from your previous Practice.
1. Registration form
New Patient Health Check Questionnaire – this will provide us with information we can use until we receive your notes. You will be invited for a new patient health check.
2. New Patient Health Check form.pdf
Medication Collection form – please complete this if you will require other people to collect your medication.
3. Medication Collection form
Patient Online Access registration form – please complete the form below for online access to your medical records and to enable you to book appointments and order repeat medication online. This gives you access to view limited parts of your record which includes medication, allergies and adverse reactions.
If you require access to view other parts of your record, such as test requests, please contact Reception.
Please note we are currently unable to offer proxy access for children and dependents due to data Protection legislation.
4. Standard Access to medical records online.pdf
Online Access information
Summary Care Record (SCR) opt out form - you will need to fill this out to let us know if you wish to have a Summary Care Record created for you or not (see link 10 on right for more information about the SCR)
5. Summary Care Record form
Please return completed forms to Reception.
We require photo ID and proof of address before we can register you.
Patients over 15 years need to be present with their ID at time of registration.