Out of Area Patient Registration

We are happy to confirm The Brooke Surgery is currently accepting patients outside our catchment area (also known as, Out Of Area Patients).

To find out whether your address is within The Brooke Surgery’s catchment area, please use the tool below:

Please continue down the page if you would like to register as an ‘Out Of Area’ patient.

If you are within the area for registration, head to our New Patient page for information on signing up with the surgery, and fill in our New Patient Registration Form.

Out of Area Registration Form

Please complete this form if you wish to register as an 'Out Of Area' patient.
Our GPs will review your application to see whether you are suitable for this type of registration. You will be contacted by one of our team to let you know if we are able to accept you as an 'Out of Area' patient.
There are some patients who may not be eligible to register as an 'Out Of Area' patient. If you fall into any of the categories below, it may be in your best interests to register with a GP surgery close to where you live:
Out Of Area Criteria*
- 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
I confirm that I do not fall into any of the above categories.
Name*
Prefix First Last
Date of Birth*
DD slash MM slash YYYY
Gender*
Address*
Street Address Address Line 2 City Postcode
Conditions of "Out Of Area" Registration*
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.
I agree to the above conditions.
Legal Declaration*
- I declare that the information I give on this form is correct and complete. I understand that if it is not correct, my application will be rejected and appropriate action may be taken against me.
Data Protection*
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.
I agree to my information being used for the purposes described above.
Comments
This field is for validation purposes and should be left unchanged.

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Monday
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Tuesday
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Wednesday
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Thursday
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Saturday
CLOSED
Sunday
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The Brooke Surgery

Out of Area Patient Registration

Out of Area Registration Form

Opening Times

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The Brooke Surgery

Out of Area Patient Registration

Out of Area Registration Form

Opening Times

Useful Links

NHS A-Z Conditions

Find Local Services

Live Well

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