Welcome to Blackthorn Health Centre

In order to complete your registration with the practice, please complete the Medical Questionaire located at the bottom of this page. Please note, this questionnaire will need to be completed per registering patient by the patient themselves or their parent / guardian / carer with permission.

 

Please remember to change your Electronic Prescription Service (EPS) nominated Chemist / Pharmacy. Failure to do so may result in any prescriptions being electronically sent to your previous Chemist / Pharmacy.

 

Please see our Appointment section for more information on how the practice's appointment system works, including our eConsultation service.

Patients are assigned a Named GP when registering at the practice. Your Usual GP can be changed at any time and does not restrict you from seeing any GP at the practice. For more information on your Named GP, please call on 023 8045 3110 or ask at reception.

For more information on how your data is shared and how to opt-out of sharing your data, please see the Data Sharing & Confidentiality section.

For the Parents / Guardians of children under 18, please also see the Healthier Together website / app for advice to support you and your child.

 

If you have any further queries, please use our Contact Us form.

 

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Online Registration

If you have not yet registered online with Blackthorn Health Centre, please use the link below to do so before completing this form.

 

JOIN THE PRACTICE

Patient's Details

Information we need to register you with the practice
Please note all fields marked with a * are mandatory for your registration

if known
for patients under 18

A patient will be deemed to be housebound when they are unable to leave their home environment through physical and / or psychological illness.   

An individual will not be eligible for a home visit if they are able to leave their home environment on their own or with minimal assistance to visit public or social recreational public services, (including shopping).

In addition, an individual would not be classed as housebound as a result of transport difficulties. You can contact one of our Good Neighbours Network to arrange transportation to and from medical appointments. The local Good Neighbours Network contact details are as follows:

Carers
Armed Forces
please use the date format: DD/MM/YYYY
please use the date format: DD/MM/YYYY

These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.

 
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Lifestyle
to be recorded as cm
to be recorded as kg
Smoking Status

If you are interested in quitting smoking, please see the NHS Quit Smoking page.

You can also call the smoking helpline on 0300 123 1044, Monday to Friday 9am to 8pm, and Saturday to Sunday 11am to 4pm.

Alcohol Consumption

alcohol consumption Image 1 unit

Audit-C Score Result

you have a score of  / 12.

If you are drinking less than 14 units of alcohol per week, then your drinking is within the UK Chief Medical Officers' low risk drinking guidelines.

But if you are drinking regularly at or above the low risk guidelines of 14 units a week, or, you are drinking six or more units - if you are female - or eight or more units - if you are male - in one single session (binge drinking), please consider the increased serious risks to your health being caused by your current drinking pattern.

For further support with your drinking, please arrange a GP appointment or go to NHS Alcohol Misuse Treatment page.

Ethnicity
 
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Medical History
please include dates where possible
please include dates where possible
please include dates where possible

 

Please include any upcoming procedures or tests and when they will next be required.

For example, blood tests and hospital procedures, (such as X-Rays, Ultrasounds, DEXA scans, etc.)

please include dates where possible
please include dates where possible
Child Health

Under 5 years old?

Please complete the additional two questions below.

to be recorded as kg
Cervical Smear History
please use the date format: DD/MM/YYYY
 
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Summary Care Record

Summary Care Record (SCR)

The Summary Care Record (SCR) system is designed to help both your GP and any emergency staff you contact when the surgery is closed to treat your health needs more efficiently.

Your information will be shared between your GP practice, our local hospital and Out Of Hours service. This will enable your GP surgery to access results and any visits you have at the hospital quickly and efficiently, but it also means that if you have an emergency and contact the Out Of Hours service or visit A&E they will have access to your current medications as well as allergies and are better able to treat you.

If you do not return this form, a Summary Care Record will be created for you based on implied consent

What happens to my information?

Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you.

We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols. For more information on these suppliers, please see our Privacy Notice.

To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence.

I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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