Patient registration

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Completion and submission required for registration

If you are already registered with us as a patient, you do *not* need to complete this form to use our econsultation service. Simply visit our econsultation page and start your consultation if required.

1. Please confirm that you agree to our privacy and data sharing policy. *

I agree to my data being stored, shared, and used for further communication in accordance with the privacy policy which can be found here for Bramley, Middleton, and Cottingley, here for Briercliffe GP Surgery, here for Gateshead Healthcare, here for Queens Medical Centre and Lynton, here for the Mayflower Group, and here for Coleridge.

2. Communication consent *

I consent to the practice contacting me by text message and/or email for the purposes of health and treatment advice, health promotion, practice news and for appointment reminders. I acknowledge that appointment reminders by text are an additional service and that they may not be sent on all occasions but that the responsibility for attending appointments or cancelling them still rests with me. I can cancel the text message facility at any time by contacting the surgery.. Text messages are generated using a secure facility but I understand that they are transmitted over a public network onto a personal telephone and as such may not be secure, however the practice will not transmit any information which would enable an individual patient to be identified.

3. To register as a Patient at one of our Practices, you must agree to the following: *

I accept that I must complete this registration form in full and that I must click "FINISH" in order for this registration to be sent to the surgery. If I do not click "FINISH" then I understand that my registration form will *not* be sent to the Practice and that I will not be registered as a new patient.