How do I....
Register?

New patients can register in person, online, or request application forms to be posted out by telephone. Patients will be notified within 14 days of any decision to reject a registration with reasons for the rejection.

Online Registration

To register online please complete the form below-

Beechwood Medical Centre Registration Form Caring About Quality Please complete where indicated or tick the appropriate box as required Mr Mrs Miss Ms   Date of Birth: NHS No: Male Female   Surname: First names: Previous surnames: Town & country of birth: Home Address: Postcode: Telephone number: Your previous address in UK:   Are you from abroad? Yes No Your first UK address where registered with a GP: Date you first came to live in UK   Are you returning from the Armed Forces? Yes No Address before enlisting Service or Personnel Number Enlistment date   If you are registering a child under 5 I wish the child above to be registered with the doctor   Marital Status Single Married Divorced   Ethnic Status White Black African Black Asian Other Asian Black Caribbean Black Other White Other       Medical History Please tick the box if you have any of the following... Heart Disease Blood Pressure Diabetes Asthma Epilepsy COPD Hypothyroid Cancer Mental Health Kidney Disease Osteoporosis Stroke Dementia/Alzheimers Learning Disability     Please list any other operations or serious illnesses you have had:   Has anyone in your immediate family under the age of 60 suffered from heart disease or stroke? Please give details of relationship and age when diagnosed. Yes No     Please list any allergies to medication you have:   Lifestyle Are you: A smoker An ex-smoker Never Smoked   If you are interested in help to stop smoking, please book in at reception for the Smoking Cessation Clinic   Alcohol How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week How many standard drinks containing alcohol do you have on a typical day when drinking? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more How often do you have six or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or almost daily   How often during the last year have you been unable to remember what had happened the night before because you had been drinking? Never Occasionally Monthly Weekly Daily     How often during the last year have you failed to do what was normally expected of because of drinking? Never Occasionally Monthly Weekly Daily     In the last year has a relative/friend/Doctor or health worker been concerned about your drinking or suggested you cut down? Yes once Yes more than once No never   How tall are you?   How much do you weight?   NHS Organ Donor registration I want to register my details on the NHS Organ Donor Register as someone whose organ/tissue may be used for transplantion after my death. Yes   No Please tick the boxes that apply Kidneys Heart Liver Corneas Lungs Pancreas Any part of my body   NHS Blood Donor registration I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood. Yes   No   CONFIDENTIALITY - TERMS AND CONDITIONS: The internet is not secure, and the transmission of this data is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions. I accept the terms and conditions above