Welcome to Meon Health Practice

If you would like to register as a with us, please complete this form

We will review your information and send you confirmation via text or email once you are registered.

If you have not registered with the NHS before, please bring ID to the practice. This could be a driving license, or passport and household bill.

Online Registration

Step 1 of 2

50%

Your Personal Details

Contact Details

NHS Number (if known) Optional

Name

Prefix

Name

First Middle Last

Previous Surname (if applicable) Optional

Gender

Date of Birth

Day

Month

Year

Home Telephone Optional

Mobile Number

Do you consent to be contacted via SMS?

Please select your preferred method of contact from the following options:

Text

Letter

Address

Street Address Address Line 2 City Post code

Previous Address

Street Address Optional Address Line 2 Optional City Optional Post Code Optional

Enter Email Confirm Email

Do you consent to be contacted via email?

Next of Kin

Do you have a next of kin?

(emergency contact person)

Name

First Last

Phone

Relationship to you

Do you consent to your next of kin discuss your medical records?

Yes

Previous GP

Have you previously registered with a GP Practice in the UK?

Yes

GP Name

Address

Street Address Address Line 2 City Post Code

What date did you enter the UK?

DD slash MM slash YYYY

Other Details

Country of Birth

Ethnicity

Religon Optional

Are you a Military Veteran?

Yes

If yes please provide the date of discharge Optional

DD slash MM slash YYYY

Which section of the military you had membership based on the following options: Optional

Carer Details

Do you have a Carer?

Are you a Carer?

Family History

Please record any significant family history of close relatives with medical problems and confirm which relative e.g. mother, father, brother, sister, grandparent.

Please choose the below conditions Optional

Relative Optional

i.e Parent, Sibling, Grandparent, Aunt/Uncle/Cousin etc

Allergies

Please record any allergies or sensitivities

Medication

Please check and include as much information about your current medication below.

Please give us your previous repeat medication list if possible, a medication review appointment may be needed: Optional

Your Lifestyle

Alcohol

Please answer the following questions which are validated as screening tools for alcohol use: AUDIT–C QUESTIONS

How often do you have a drink containing Alcohol?

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

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

Smoking

Do you smoke?

How many cigarettes did/do you smoke a day?

Would you like help to quit smoking?

For further information, please see:
www.nhs.uk/smokefree

Height and Weight

Height

Weight

Electronic Prescribing

If you would like your prescriptions to be sent electronically, please provide details of the pharmacy you would like to use: Optional

Patient Newsletter

Would you like to receive patient newsletters by email?

Patient Participation Group

Would you like to be involved in our Patient Participation Group?

I confirm that the information I have provided is true to the best of my knowledge.

Name

Date

Day

Month

Year

Your Health Record

Do you consent to your GP Practice sharing your health record with other organisations who care for you?

I wish to give EXPRESS CONSENT for medication, allergies and adverse reactions only to be included in my Summary Care Record

I wish to give EXPRESS CONSENT for medication, allergies, adverse reaction and additional information to be included in the my Summary Care Record

I DO NOT CONSENT to have my Summary Care Record and do not wish to have one

Do you consent to your GP Practice viewing your health record from other organisations that care for you?

Yes (recommended option)

Your Summary Care Record (SCR)

Do you consent to having an Enhanced Summary Care Record with Additional Information?

Yes (recommended option) Optional

No Optional

Do you wish to have online access to your health record?

Please select

Yes Optional

No Optional

I wish to access my medical record and understand and agree with each of the following statements

I wish to access my medical record and understand and agree with one of the following statements

I have read and understood the ‘Important Information’ section below

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

Access to GP Online Services

Important Information – Please read before completing form below

If you wish to, you can now use the internet (via computer or mobile app) to book appointments with a GP, request repeat prescriptions for any medications you take regularly and look at your medical record online. You can also still use the telephone or call in to the surgery for any of these services as well. It’s your choice.

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 are unable to 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.

If you print out any information from your record, it is also your responsibility to keep this secure. If you are at all worried about keeping printed copies safe, we recommend that you do not make copies at all.

During the working day it is sometimes necessary for practice staff to input into your record, for example, to attach a document that has been received, or update your information. Therefore you will notice admin/reception staff names alongside some of your medical information – this is quite normal.

The definition of a full medical record is all the information that is held in a patient’s record; this includes letters, documents, and any free text which has been added by practice staff, usually the GP. The coded record is all the information that is in the record in coded form, such as diagnoses, signs and symptoms (such as coughing, headache etc.) but excludes letters, documents and free text.

Before you apply for online access to your record, there are some other things to consider. Although the chances of any of these things happening are very small, you will be asked that you have read and understood the following before you are given login details.

Forgotten history

There may be something you have forgotten about in your record that you might find upsetting.

Abnormal results or bad news

If your GP has given you access to test results or letters, you may see something that you find upsetting to you. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them.

Choosing to share your information with someone

It’s up to you whether or not you share your information with others – perhaps family members or carers. It’s your choice, but also your responsibility to keep the information safe and secure.

Coercion

If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time.

Misunderstood information

Your medical record is designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information within your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification, please contact the surgery for a clearer explanation.

Information about someone else

If you spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible.

For further information, please see:
www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/gp-online-services.aspx

Adult New Patient Registration

Welcome to Meon Health Practice

Online Registration

Your Personal Details

Next of Kin

Previous GP

Other Details

Carer Details

Family History

Allergies

Medication

Your Lifestyle

Alcohol

Smoking

Height and Weight

Electronic Prescribing

Patient Newsletter

Patient Participation Group

Your Health Record

Your Summary Care Record (SCR)

Access to GP Online Services

Important Information – Please read before completing form below

Forgotten history

Abnormal results or bad news

Choosing to share your information with someone

Coercion

Misunderstood information

Information about someone else

Our Locations