Regular Patient Application

If you have a permanent or temporary address in Widnes and would like to register with us, please complete the online form below.  PLEASE COMPLETE ALL SECTIONS OF THE FORM – FAILURE TO DO THIS WILL RESULT IN DELAY TO YOUR REGISTRATION

Before completing the form, please note:

  • You must agree with and comply with our GP/Patient Responsibilities.
  • Your registration is not complete until you have received your new patient check.
  • Repeat medications will not be issued at new patient registration.  You must obtain a supply of repeat medications from your current GP who are required to provide you with one month’s supply.

If you complete a registration form then fail to contact us within two weeks, your application will be deleted from our systems.

We are asking patients to download the NHS App to assist with various functions within the practice.  You can order repeat medication, manage appointments, view your medical record and consult with our GP online.

Providing Identity is not mandatory. We may on occasion ask to see some form of identity as proof that you live within our boundary area.

Homeless applicants are free to register with our practice. Please state you are of no fixed abode and provide details of any support you are receiving at present.

Asylum seekers and refugees, homeless people and Roma or traveller groups can click here find out about how to register with a local GP practice. They also advise on steps to take if a practice declines a new registration.

Using-the-NHS-Information-for-visitors-from-abroad                    GMS12017

BEFORE registering with us, please read the following pages:

Your Options                    DNA Policy                Summary Care Record          GP/Patient Responsibilities

New Patient Registration Form
*
Sex
Address
City/Town
County
Postcode

Communication

It is important that we can contact you if we need to. Please ensure that you keep you contact details up to date. You can use the NHS App or other online services provider to update your details if this information changes.
This service allows you to receive appointment reminders, cancel appointments and receive invitations to clinics etc)
Required if this is your preferred method of contact

Information about you

You will also be required to complete a GMS1 form when you attend for a new patient check

Information about your Next of Kin

Please provide us with details of who we can contact in an emergency. Note that no medical information will be revealed without your express consent

Online Access

We are asking all of our patients to download the NHS App from the app store on your smart device (phone/tablet etc).

You can book an appointment, manage your referrals, order a prescription, get advice, submit an online consultation and more using the NHS App. The app also holds your Covid vaccine passport. Soon, all NHS app users will be able to access all prospective data added by us into their medical records.

Previous GP

Please tell us who your previous GP was (required so that we can request any medical records)
If new to the UK please type None

Carers

A carer is someone who spends a significant proportion of their life providing unpaid support to family or friends. This could be caring for a relative, partner, child or friend who is ill, frail, disabled or has mental health or substance misuse issues.
Formal care givers are those who are paid to give care, whereas informal care givers are not paid to provide care.
An informal carer includes any person, such as a family member, friend or neighbour, who is giving regular, ongoing assistance to another person without payment for the care given.
Formal care givers are those who are paid to give care, whereas informal care givers are not paid to provide care.
An informal carer includes any person, such as a family member, friend or neighbour, who is giving regular, ongoing assistance to another person without payment for the care given.
Carer's Address
City
State/Province
Zip/Postal
Country

Medication

For information on help with prescription costs visit our Information section.
If you do not want to sign up to the NHS App, you can choose to request repeats by placing the tear off slip from your prescription in the post box at Reception

Further Information

A DNAR (do not attempt resuscitation) form is a document issued and signed by a doctor, telling your medical team not to attempt cardiopulmonary resuscitation (CPR).
Do you currently attend hospital outpatients? *
Do you have a support worker *
Have you ever served in Her Majesty’s Armed Forces? *

Summary Care Record

For further information about Summary Care Rec ords - please view our website pages https://www.oaksplacesurgery.nhs.uk/imt/summary-care-records/

Declaration

Please ensure you have read all the documents and web pages referred to before ticking these boxes, failure to adhere to responsibilities in some cases could result in removal from our list
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