How to Register

1. Ensure you have at least 1 month of your child’s medication. It can take up to 4 weeks for the medical notes to be transferred to us making it difficult for us to issue repeat medication. If possible, obtain at least a month’s worth of medication from your previous practice before registering with us.

2. Check that you live within our practice boundary. We will not register people living outside this area unless you have been allocated to us by the Healthboard.

3. Identification. This is no longer needed to register with a practice. If deemed necessary however, we are able to ask for identification at any point to confirm your child’s identity and address for reasons of data protection and practice boundaries.

4. Complete the Registration form below. Your child should then be registered within 48 hours.

Registration Form

Registration (Child < 18)

Admin message to Practice

EXISTING PATIENT RECORD. Reports they have been a patient of the practice in the past – please ensure you check for their old record in Vision.

CHILD’S DETAILS

Will the child be in the area for more that 3 months? (If not, please complete a temporary resident form)

Yes

Have they ever been a patient at this practice in the past?

Yes

Forenames

Surname

Date of Birth

Sex at Birth

Male

Female

How old is the child?

> 5 years old

4 years old or younger

Address

EH29, EH52 and some within EH30 and EH28 as per the boundary

Town

EH29, EH52 and some within EH30 and EH28 as per the boundary

Postcode

EH29, EH52 and some within EH30 and EH28 as per the boundary

Which town are you are nearest to? (For assigning you a health visitor)

Kirkliston, Newbridge or Ratho

Winchburgh

Community Health Index (CHI) number

Town of birth

Found on the birth certificate.

Country of birth

Found on the birth certificate.

Parent or Guardian Details

Who looks after the child? (Primarily)

Mother

Father

Guardian

Mother’s Name

Mother’s Date of Birth

Father’s Name

Father’s Date of Birth

Guardian’s Name

Guardian’s Date of Birth

Guardian’s relationship to child

Mobile

Is the child’s father also registered at this practice?

Yes

Father’s Name

Father’s Date of Birth

HELP US TO TRACE THE PREVIOUS GP HEALTH RECORDS BY PROVIDING THE FOLLOWING INFORMATION

Have they ever been registered with a GP practice in the UK?

Yes

Address in UK when they were last registered with a GP

Town/City

Postcode

Name of previous GP Practice in UK

Address of previous GP Practice in UK

Town/City

Postcode

Has the child arrived to the UK from abroad?

Yes

Date first came to live in the UK

If previously resident in the UK, date of leaving

The most recent country of residence

Medical History

Allergies to Medication – Do they have any?

Yes

Medication Allergies – please list below including the reaction

This box is expandable

Medical History

Condition

Add another condition Remove

Regular Medication

Medication (include dose and frequency)

Add another medication Remove

Both Winchburgh and Kirkliston pharmacies collect prescriptions from the practice daily. Where would you like the prescriptions to go?

Winchburgh Pharmacy (Right Medicine)

Kirkliston Pharmacy (Well Pharmacy)

I would prefer to collect the prescriptions from the practice myself

HOW THE NHS USES INFORMATION

The information you have provided will be used by NHS Scotland to carry out its various functions and services including scheduling appointments,
ordering tests, hospital referrals and sending correspondence. Read more using the link below.

“How the NHS handles your personal health information”

PATIENT DECLARATION

I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable
NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, the minimum necessary information from this form could be disclosed to relevant authorities.

I understand that more comprehensive information about how NHS Scotland handles my data is available from NHS Inform.

This information can be provided in other languages and formats on request. The NHS Inform helpline provides an interpreting service.

What is your name?

Your relationship to the patient

Your mobile number in case we need to contact you

Signature

Clear

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our privacy policy to discover how we protect and manage your submitted data.

Consent

I agree to the privacy policy

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