Under 16s New Patient Registration

To register with our practice please follow the link below to complete the online registration form. Due to the current ‘COVID 19’ outbreak, please DO NOT COME INTO THE SURGERY at this present time 

Completing this form is the first step to registering with the practice. You will need to provide some identification prior to you acceptance here at the surgery, please send to the following email address:  sms.hammersmithsurgery@nhs.net

 

  • Patient Details
  • Health Information
  • Further Information
0% Complete
1 of 3

Patient's Details

About You (Parent/Guardian)

Mobile number for text message reminders.

Carers Information

eg. someone who is ill, frail, disabled, has mental health/emotional support issues or substance misuse
eg. family member, friend or neighbour
Preferably a mobile number
eg. Wheelchair, hearing aid, braille, lip reading, sign language etc.

Ethnic Origin

Medical Records

Please help us trace your previous medical records by providing as much of the following information as possible.

If you are from abroad

Please include dates/years.