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Pre-registration with the practice

PreRegistrationIf you wish to pre-register click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. Please visit the surgery at your earliest convenience in order to sign the form to confirm that the details are correct. We are unable to fully process your registration until you have done this and consequently we can not begin the process of transferring your past medical notes.

Pre-registration Form

When you register you will also be asked to fill out a medical questionnaire. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too, which you may fill out and send to us (please note that this is different to our current surgery questionnaire and we are working towards a single standardised form). When you come to the surgery you will be asked to sign this form to confirm that the details are correct.

Online medical questionnaire for new patients

Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.


Alternatively you may print off a registration form, fill it out and bring it with you to the practice at your earliest convenience.

Registration Form

Noticeboard

Join the Practice

Register online - our lists are open to accept new patients living within our practice area.

Already a patient?

Join our patient reference group and help us get better still!

Churchfields Surgery settles in to the BHI Parkside Building

Around two years of medical care in our "new" building and we are still excited about our fabulous modern location... more

24 hour bookings and prescriptions

Learn about how to access online services such as appointment booking and prescriptions

Change 4 Life

 
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