Registering

To register at the Orchid House Surgery, please bring your medical card, some form of photographic identification (eg passport or photo driving licence) and proof of address (eg recent utility bill) to the surgery where the receptionist will register you with the practice. If you do not have a medical card, please ask for an application form. Temporary residents, who are also required to provide photo ID, are registered on a special form at reception. Patients who wish to register online will first need to bring proof of ID and address into the surgery before registration is accepted.

We do not discriminate on the grounds of race, gender, social class, age, religion, sexual orientation or appearance, disability, medical condition or on the perceived cost or extent of any work a patient is likely to generate by virtue of their clinical condition.

Orchid House Surgery does not operate a system of 'personal list'. Patients are registered with the practice and not an individual GP. Therefore, after registration, you may see any of our doctors. You are still able to book with your preferred GP, but please be aware that this type of appointment can take longer because of the way we work our system.

We offer a daily triage telephone consultation with the duty doctor. The receptionist will take your telephone contact details and the doctor will ring you back to discuss the nature of your problem. If he/she needs to see you in surgery then you will be given a time to come in and see them that day.

To register online please complete the form below-

1Register Details

Title:Please Choose...MrMrsMissDrProffOther

If Other, please specify:

Date of Birth:

Town & country of Birth:

NHS no. (if known):

Male / Female:Please Choose...MaleFemale

Surname:

First Names:

Telephone:

Mobile:

How you describe your ethnic origin?

Email Address:

Address:

Are you a carer for a sick/elderly person(s)? Please Choose...YesNo

If yes, who for?

2Previous Medical Records

Your previous address in the UK

Postcode

Name of your previous doctor at that address

Address of previous doctor

Are you from abroad? Please Choose...YesNo

Your first UK address where registered with a GP

If previously resident in the UK, date of leaving

Date you came first came to the UK

Are you returning from the Armed Forces? Please Choose...YesNo

Address before enlisting

Service/Personnel No.:

Enlistment date:

3Past illnesses

Please list all serious illnesses, hospital admissions and operations:

Please state the problem and roughly the date that it occurred.

Please list any serious family illnesses we should know about on your mother's side:

Please list any serious family illnesses we should know about on your father's side:

Do you have any history of the following:

High blood pressure

High Cholesterol

Cancer

Stroke/Tia

Epilepsy

Asthma/COPD

Heart Disease

Diabetes

Pacemaker

Thyroid Disorders

Mental Conditions (eg Depression)

4Drugs / Treatment Medication

Do you take any prescribed drugs?Please Choose...YesNo

If yes, please list below, including the dose:

Do you have any drug allergies? Please Choose...YesNo

If yes, please list:

5General Information

Heightfeet & inches

Weightstone & pounds

Waist Measurement inches

Smoking

Are you a smoker? Please Choose...YesNo

If so, approximately how many a day?

We run a very successful SMOKE STOP GROUP. Would you like to attend? Please Choose...YesNo

Are you an ex-smoker? Please Choose...YesNo

If yes, please state the date you gave up approximately:

Please tick if you have never smoked before:

Alcohol

Approximately how much do you drink per week?

Exercise

Do you take regular exercise? Please Choose...YesNo

Problems

Are there any problems which you feel are affecting your health? (e.g. employment, housing, family or drugs) Please Choose...YesNo

If yes, please give details:

6Women only

When and where did you last have a cervical smear test?

Have you had a hysterectomy? Please Choose...YesNo

If yes, which year?

Have you ever had a mammogram (breast x-ray)? Please Choose...YesNo

If yes, when was this?

Number of pregnancies?

Number of pregnancies?

Are you on the pill? Please Choose...YesNo

When is your next prescription due?

Have you a coil (IUCD) in situ? Please Choose...YesNo

If yes, when was this last checked?

7NHS Organ Donor Registration

I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my deathPlease Choose...YesNo

Please check as appropriate:-

Kidneys

Heart

Liver

Corneas

Lungs

Pancreas

Any part of my body

Please note that we are unable to process your online registration until we receive copies of either driving license/passport and utility bill to confirm your identity. So please ensure that this information is presented to the front desk receptionists as soon as possible.

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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.

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