WHO CAN REGISTER
If you are ordinarily resident in the UK and live within our Practice area:
We accept new patients who live in our practice area as fully registered patients. Our practice area is Southam town and surrounding villages. Please fill in the form below to register as a patient.
If you are ordinarily resident in the UK but live outside our practice area, we can still accept you as an 'Out of Area Patient' but this means we will not be able to visit you if you need a home visit. More details are available by clicking on Out of Area Registration - GP Choice. Please fill in the form below to register as an 'Out of Area' patient.
Please click here to check whether you are in our practice area.
If you are not ordinarily resident in the UK you can still register as a patient but you will need to come into the surgery to do so.
FILLING IN THIS FORM
Please provide as much information as you can and ensure that you complete all questions marked as 'mandatory'.
You will receive a confirmation reference once your form has been successfully submitted. If you do not receive this, please check that you have completed all mandatory fields and then re-submit your form.
Successfully submitted forms will be processed within 48 hours. We will only contact you if there is a problem with your registration.
Please contact us if you would like to make an appointment to see the practice nurse (or doctor if you are on regular medication) for a new patient health check. This will ensure that our records are accurate and all routine checks to promote your health and well-being (such as blood pressure/smear tests/mammograms) are up-to-date.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key known only to the GP practice and is
accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.