Wheatfield Surgery
60 Wheatfield Road
Luton
Bedfordshire
LU4 0TR
Tel 01582 601116
Fax 01582 666421
Dear Parent / Guardian
Welcome to Wheatfield Surgery.
To register at our surgery the Department of Health requires that we will need to obtain documentation to prove that you are a permanent resident in the UK. Entitlement to NHS treatment is based on residency not citizenship. Anyone who can provide evidence that they have been legally resident in the UK for the past 6 months will be entitled to register.
To register at the surgery we will need:
Step 1 – NHS number (this can be obtained from your previous GP surgery)
Step 2 -Previous GP name and address (to obtain medical notes)
Step 3 – if your child is on regular medication we will need previous medication slips or print out from the previous surgery stating which medications you are currently on.
Step 4 – We will also need a copy of the child’s red book to see which immunisations the child has received.
This paperwork needs to be filled out when you attend your new patient registration appointment. During this appointment your registration will be finalised.
Wheatfield Surgery is a very busy surgery, failure to attend this appointment may result in your registration being declined.
OVERSEAS VISITORS
Ensure the following information is provided at your new registration screening:
Where have you been living for the past 12 months?
On what date did you return to the UK?
Which county did you come from?
What is the purpose of your visit to the UK?
Is it your intention to reside in the UK permanently? (if yes, please state why)
Can you prove you have the right to remain in the UK? (UK passport is insufficient evidence as citizenship is irrelevant)
If you have answered Yes to the above questions you must provide documentary evidence i.e. UK entry clearance visa, Home Office correspondence etc.
If these details are not provided we will not be able to continue with the registration. Unfortunately, if you may require seeing a GP or a nurse while your application is being processed, you may be asked to pay a charge for each appointment.
We request that you complete the new patient information form overleaf in full.
NEW PATIENT INFORMATION FORM (under 5’s)
Surname / ForenamesDate of Birth / Telephone Number
Address
Postcode
Mothers Name / DOB
Fathers Name / DOB
Brother (s) / DOB
DOB
DOB
Sisters (s) / DOB
DOB
DOB
Past medical history:Please give any details including dates/year of any operations or medical problems including ongoing illness e.g. asthma, eczema
Details of regular medication taken
Summary Care Record - a SCR has been created for you, if you do not wish us to create it please put NO in this box. Phone 0300 123 3020or visit if you have any queries. Y / N
Please give details of any allergies including drugs and the reaction caused:
Have any close relatives suffered from: Please give details
Diabetes / Tuberculosis
Asthma / High blood pressure
Heart problems / Glaucoma
Cancer / Stroke
High Cholesterol / Jaundice
Mental Illness / Cancer
Any other major illness
Urine Test / Glucose / Protein
Height
Weight
Ethnic Origin
Routine immunisations are these up to date? It is never too late to immunise. Interrupted courses may be continued. Please bring in your Red Book which we will photocopy.
At two months
Polio Tetanus
Diptheria Hib
Whooping Cough
Pneumoccocal / At three months
Polio Tetanus
Diptheria Hib
Whooping Cough
Meningitis / At four months
Polio Tetanus
Diptheria Meningitis
Whooping Cough
Pneumoccocal Hib
At twelve months
Hib / Men C / At thirteen months
Measles Mumps
Rubella
Pneumoccocal / At three to five years
Diptheria Hib
Tetanus Rubella
Polio Measles
Thank you for your co-operation Wheatfield Surgery Partners