Online 'Pre-Registration' With The Practice

PreRegistrationIf you wish to pre-register click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. When you visit the surgery for the first time you will be asked to sign the form to confirm that the your details are correct.  At this point we will also need to see proof of identity and adress in order to finalise your registration with the practice.

As it can take a considerable time for us to receive your medical records, we require you to also complete the online medical questionnaire for new patients (link below).

ONLY WHEN THE PRACTICE HAS RECEIVED BOTH OF THESE FORMS ARE WE ABLE TO CONSIDER YOUR REGISTRATION.

Pre-registration Form

Online Medical Questionnaire For New Patients

PLEASE READ IMPORTANT INFORMATION BELOW BEFORE REGISTERING

 

During the pandemic we are trying to reduce footfall within the practice, so in order to complete you registration please email us on dudleyccg.evehill@nhs.net with your 2 forms of ID which will be proof of ID and address. You will be contacted if we do not receive these forms of ID. If you do not have the appropriate ID please contact the surgery.

We will inform you via text message using the contact number you provide on the registration form once you are registered. This message will also include further information about the Practice.

Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.


Alternatively you may print off a registration form, fill it out and bring it in with you on your first visit to the practice.

pdfRegistration Form

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