New Patient Registration (Under 16)

If you would like to register a child with the practice, please use this form.

To register a new patient you will need to live within our practice boundary.

Please be aware that when registering:

  • As a new patient, your child is entitled to a new patient check if you want one. To book one, please contact our reception and ask to book a new patient check with a healthcare assistant.
  • We will only prescribe or issue sufficient medication to tide you over until a medication review has been completed. Please provide a list of your current medication when you come into the surgery to complete the child’s registration.
New Patient Registration (Under 16)

New Patient Registration (Under 16)

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Sex *
Any responses we send will go to this email address.
We may want to contact you about your child by email, send appointment reminders to your mobile and leave messages on your answering machine or mobile phone. Please select all that you do not consent to:
Is the child a 'Looked after Child'?

A child who is being looked after by their local authority is known as a child in care. They might be living: with foster parents, at home with their parents under the supervision of social services or in residential children’s homes.

Is the child someone in foster care, residential care, kinship care or who is not your child?

Can the named person consent for the medical treatment of the child?

Ethnicity

Please specify the ethnic group that the child is considered to belong to:
Does the child speak English?
Does the child read English?

Next of Kin / Emergency Contact

Are they next of kin?

Next of Kin / Emergency Contact

Are they next of kin?

Allergies

Does the child have any allergies?

Carers

Does the child have a carer?
Is the child a carer for someone?
Does the child give us permission to discuss their medical record with their carer?
Do they look after someone who is a patient of Paston Surgery?
Please specify: