New Patient Registration Form

- Women who are or may be pregnant
- Adults with a safeguarding need
- People living with complex mental health conditions
- People with complex physical, psychological and social needs
- People living with dementia
- Older people with conditions related to frailty
- People requiring end of life care
- Parents of children who are on the ‘Child at risk’ protection register
- People with learning difficulties
- People with drug dependence

If you register as an 'Out Of Area Patient', do you agree to attend The Brooke Surgery when you need a face to face appointment (but not for telephone, email/message, or video appointments)?

If you are too ill to attend in person, or we are unable to help you over the phone, by video, or by message/email, do you agree to call NHS 111? The NHS 111 service will be able to tell you about access to local services or, where necessary, arrange a home visit.

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 is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.