The Oak Tree Centre, 1 Oak Drive, Huntingdon, Cambridgeshire, PE29 7HN

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NHS

Telephone: 01480 483100

Registering as a patient.

Registration Form

Register as a patient at Acorn Surgery.
The name you would like us to use.
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For safety reasons, if you are registering a child, please provide details of the vaccinations they have had so we can update their medical record.
Do you identify with the gender you were assigned at birth?

6. Contact Details

Preferred Contact Method
Preferred Contact Method
Preferred Contact Method

7. Next of Kin

8. Are you a carer?(Required)
If no, go to question 12
IF YES
11. Are they registered at Acorn Surgery?

Do you have a carer?(Required)
If no, go to question 16 - If yes, please ask Receptionist for a Carer’s consent form
Is your carer a patient at Acorn Surgery?

Will you require translation services?(Required)
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Select one

Ex Smoker
Would you like help to quit smoking?

• You take ANY prescribed medication. • You are aged 45+ and have not had a blood pressure check in the last 2 years. • We offer all our patients aged 40-74 who do not have a long term condition (e.g. diabetes, asthma, heart disease, kidney disease, COPD) a free Health Check. Please make an appointment for a Health Check when you register with us.
Unless you inform us otherwise, by signing below you give your consent for us to send SMS texts to confirm appointments and appointment reminders, to give information about test results and to send you essential and important messages to the personal mobile phone number you have provided on this form. It is your responsibility to update us of any change to your mobile phone number so that we can keep accurate records and contact you if required. If you are on repeat medication it is vital that you arrange an appointment as soon as possible after registering with the Practice and provide us with accurate details of the medication you are taking. It is vital to check that all of your usual medication is provided on your first issue. I understand that I must request my repeat medication AT LEAST 48 hours before I need a further supply and that I must ensure I have sufficient medication from my last GP Practice.
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