New Patients

Please fill in the registration form below. Your registration is usually processed within 24 hours (up to 48 hours) if the form is complete.

Please note: Streatham Place Surgery is merging with Edith Cavell Surgery on 1 October 2020. If you are a Streatham Place Surgery patient, please complete the form below selecting “Streatham Place Surgery – pre-registering for Edith Cavell Surgery“. Find out more about this >>

*NEW* New Patient Registration Form

Personal Details

Complete the registration form below with the details of the child

Please use this date format: DD/MM/YYYY
Please select your sex as recorded at birth.

Language Support

Do you need an interpreter?
Do you use any of the following?

Contact Details

Please include postcode
Have you live at your current home address for 3 years or more?
Were you born in the UK? *
Please use this date format: DD/MM/YYYY

Next of Kin

HIV Screening

We routinely offer new patients free HIV screening checks. Would you like us to organise this check for you?

Child Under 16 Registration

Protection Plan/Foster Care Information
Parents/Carers Details

Mother/Carer
Father/Other Carer
Child's School Details
Please advise if the child has had any of the following immunisations (you can check your child's red book).

Age due: 8 weeks

Age due: 12 weeks

Age due: 16 weeks

Age due: 12 months

Age due: 3 years 4 months or soon after

Your Information

Summary Care Record

A summary care record (SCR) is an electronic summary of key health information. It will hold limited essential information derived initially from your GP record. This will include medication, adverse reactions and allergies. If you wish to know more information regarding the system and the benefits please ask reception. Alternatively, visit the website: www.nhscarerecords.nhs.uk or call 0845 603 8510

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