New Patients

Register with Slaidburn Country Practice

If you are new to the area and wish to register with the Practice please complete the form below – each person registering will need to complete a form.
Once you have completed and sent the form/s, you will be sent a new patient medical questionnaire. The questionnaire will need to be returned to the Health Centre and you will need to provide proof of identification before you can be registered with the practice.

Temporary Registration
Please note we are happy to see and treat anyone who is in the area for a short time – you will need to fill a Temporary Registration form in at the surgery so please allow extra time before your appointment is due for this to be done.  

You will need to complete one of these forms for each person you wish to register with our Practice. Those fields marked with an * are required.

Register (GSM1)
Title:
Sex:
Address
Address
Postcode
City
Country

Please help us trace your previous medical records by providing the following information:

Your previous address in the UK
Your previous address in the UK
Postcode
City
Country
Address of previous doctor
Address of previous doctor
Postcode
City
Country

If you are from abroad:

Your first address where registered with a GP
Your first address where registered with a GP
Postcode
City
Country

If you are from the Armed Forces:

Address before enlisting
Address before enlisting
Postcode
City
Country

If registering a child under 5:

If you need your doctor to dispense medicines and appliances * :

* Not all doctors are authorised to dispense medicines.

NHS Organ Donor registration:

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

Please tick as appropriate:
Or only my:

NHS Blood Donor registration

Emergency Contact

Address:
Address:
Postcode
City
Country