New Patient Registration

Before you apply to register with the practice it is important to make sure that you are within our practice area. Click here for our Practice Area map and postcode checker

All new patients wishing to register must complete a registration form and fill out a Health Questionnaire.

If you would like to register and live within the practice boundaries please complete the below registration forms and email the completed forms to bexleymedicalgroup@nhs.net.

Alternatively you can put them in the letter box outside the King Harold's Way Surgery, Erith Health Centre and Hurst Place Surgery.

Please wherever possible submit a copy of proof of adress and photo ID for an adult and the birth certificate and red book for a child, along with the completed form. If you are submitting a form online, please email these documents to bexleymedicalgroup@nhs.net with the form submission number.

Kindly note that submitting ID is not compulsory.

GP registration form GMS1

New patient health questionnaire (PDF, 538KB)

Patient Online registration form (PDF, 223KB)

The surgery is now offering Electronic Prescription Service, which will be able to save your time by avoiding unnecessary trips to your GP. EPS makes it possible for your prescriptions to be sent electronically to the pharmacy or dispenser of your choice. Please fill up the form below and attach with the registration form.

EPS nomination form

When Registering As A New Patient It Is Good To Know:

If you fail to complete the form properly, it is likley that we will be unable to register you and have to spend time contacting you to edit it so please take your time when filling it in.
That it can take up to a month to be uploaded as a new patient from when you submit to us your forms.
You will usually receive a text message confirming when you have been registered.
The Practice will be unable to do things like provide you with a repeat prescription or appointments until you are registered.
If you was previously registered with another Practice then we will request your medical records from them however it can take up to six months for these to come through. Therefore, it may be a good idea for you to request a "brief summary" from your previous Surgery before you register with us and hand it in with your registration forms. That way, if you want a repeat prescription for example then the process will be easier when you become a registered patient with us as our GP's will have it in writing that you are officially on that medication.

Interpretation Services That Bexley Medical Group Can Offer:

Bexley Medical Group is proud to offer a wide range of interpretation services to our patients and we strive to support our patients with any communication needs.

Patients should make us aware If English is not their first spoken language / they are deaf and would like us to book them an interpreter for appointments when registering as a new patient. This will be recorded on their notes but please inform us when making an appointment if an interpreter will be required to ensure that a booking is made.

We can request for an interpreter to attend appointments with our patients who are: Non English speaking and deaf (via a BSL sign language interpreter.)

Pre-Registration Form

When you come to the surgery you will be asked to sign this form to confirm that the details are correct.

Access to medical records services

Click here to download information that you need to read before requesting online access to your medical records. Click here to download (PDF, 223KB)

Please select the practice location most relevant to this Online Form submission:

New Patient Registration

Title

Surname

First names

Any previous surnames (if applicable)

Date of Birth

Gender

Town & Country of birth

NHS Number

Home Address

Postcode

Home telephone number

Work telephone number

Mobile Number

Email address

Please help us trace your previous medical records by providing the following information

Previous address in the UK (if applicable)

Postcode

Name of previous doctor

Address of previous doctor

If you are from abroad

Your first UK address where you registered with a GP if you were previously living abroad

Postcode

If previously a resident in the UK, date of leaving

Date you first came to live in the UK (if applicable)

If you are returning from the Armed Forces

Please indicate if you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas

Address before enlisting

Postcode

Service or Personnel Number

Enlistment date

Date left Armed Forces

If you need your doctor to dispense medicines and appliances*

* Not all doctors are authorised to dispense medicines

Do you live more than 1.6km in a straight line from the nearest chemist

Would you have serious difficulty in getting them from a chemist

PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

Anybody in England can register with a GP practice and receive free medical care from that practice. However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK. Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges. More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment. The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

Please select one of the following statements

I understand that I may need to pay for NHS treatment outside of the GP practice

I understand I have a valid exemption from paying for NHS treatment outside of the GP practice. This includes for

example, an EHIC, or payment of the Immigration Health Charge (“the Surcharge”), when accompanied by a valid visa. I can provide documents to support this when requested

I do not know my chargeable status

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate action may be taken against me.

NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS

Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

Do you have a non-UK EHIC or PRC

If yes, please enter details from your EHIC or PRC below:

Country Code

Name

Given Names

Date of Birth

Personal Identification Number

Identification number of the institution

Identification number of the card

Expiry Date

PRC validity period from

PRC validity period to

Do you have an S1 (e.g. you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state).

How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process. Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

Name And Address Of School / College (All Patients Aged 18 And Under)

Name of School / College

Address

Smoking Status

Please select one of the following

How many: Cigarettes per day, Cigars per day, Ounces of tobacco per day

Ex-smokers

If you used to smoke, when did you start

When did you stop

When you smoked how many: Cigarettes per day, Cigars per day, Ounces of tobacco per day

Alcohol Status

Please select one of the following

If you currently drink or are an ex-drinker, please answer the following

Units of alcohol per day

Date started

Date stopped

Height & Weight

Height

Weight

Exercise

Do you take regular exercise

Please select the most relevant option

Medical History

Provide details of any medication you are taking:

Please list below any current or significant past medical history (i.e. hospital admissions)

Are any of your close relatives (mother, father, brother or sister) suffering with/or suffered from any of the following

Heart Attack/Disorder

If yes, which relative/s

Stroke

If yes, which relative/s

Asthma/COPD

If yes, which relative/s

Diabetes

If yes, which relative/s

High Blood Pressure

If yes, which relative/s

Have any of your close relatives died from either of the following

Heart Attack/Disorder

Stroke

Have you ever been prescribed antidepressants

Do You suffer from any allergies

If yes please give details

Are you a carer

Do you have any learning difficulties

If yes, please give details

Accessible Information Standard

The Accessible Information Standard aims to ensure that patients (or their carers) who have a disability or sensory loss can receive, access and understand information, for example in large print, braille or via email, and professional communication support if they need it, for example from a British Sign Language interpreter.

This applies to patients and their carers who have information and / or communication needs relating to a disability, impairment or sensory loss. It also applies to parents and carers of patients who have such information and / or communication needs, where appropriate.

Individuals most likely to be affected by the Standard include people who are blind or deaf, who have some hearing and / or visual loss, people who are deaf blind and people with a learning disability. However, this list is not exhaustive.

Do you have communication needs

If yes please complete the rest of the questions in this section. If no you can move on to the next section

Do you need a format other than standard print

Do you have any special communication requirements

How do you prefer to be contacted

What is your preferred method of communication

How would you like us to communicate with you

Can you explain what support would be helpful

What is the best way to send you information

What communication support could we provide for you

If you have a carer do they need communication assistance

If ‘Yes’ what is your Main Carer’s name

Do you consent to the practice contacting your main carer regarding your care

What is the best way to contact them

Alcohol Questions

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year

How often during the last year have you failed to do what was normally expected from you because of your drinking

How often during the last year have you been unable to remember what happened the night before because you had been drinking

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down

How often do have a drink containing alcohol

How many units of alcohol do you drink on a typical day when you are drinking

How often during the last year have you found that you were not able to stop drinking once you had started

How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session

How often during the last year have you had a feeling of guilt or remorse after drinking

Have you or somebody else been injured as a result of your drinking

Access to GP online services

I wish to have access to the following online services (tick all that apply):

Booking appointments

Requesting repeat prescriptions

Application for online access to my medical record

I wish to access my medical record online and understand and agree with each statement

I have read and understood the information in the leaflet download

I will be responsible for the security of the information that I see or download

If I choose to share my information with anyone else, this is at my own risk

I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement

If I see information in my record that it not about me, or is inaccurate I will log out immediately and contact the practice as soon as possible

Important Information – Please read

It will be your responsibility to keep your login details and password safe and secure. If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately.

If you can’t do this for some reason, we recommend that you contact the practice so that they can remove online access until you are able to reset your password.

Electronic Prescription Service Nomination

Name and address of nominated dispenser

Your next of kin details

Title & Full Name

Telephone number/s

Address (including post code)

Relationship with Next of Kin

Privacy 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 through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to King Harold's Way Surgery • 171 King Harold’s Way, Bexleyheath, Kent, DA7 5RB.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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Key Information

New Patient Registration

When Registering As A New Patient It Is Good To Know:

Interpretation Services That Bexley Medical Group Can Offer:

Pre-Registration Form

Access to medical records services

Privacy Protection