Please complete both this patient information form and the patient registration form. Both parts are required for registration at the surgery.
It is possible for other health organisations that use the same clinical system as us, such as the urgent treatment centre, to be able to see your health records. These records are not shared with anyone outside of healthcare organisations relevant to you.
Please bring in two forms of identification:
1) Photo ID
2) Proof of address
When your registration has been accepted, you can make an appointment with the Practice Nurse for a 'New Patient Health Check'
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 and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to The Old Fire Station Surgery • 68a Portsmouth Road, Woolston, Southampton, SO19 9AN.
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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