01522 303600
  • Family doctor services registration (GMS1)

  • Please help us trace your previous medical records by providing the following information.

  • If you are from abroad

  • Were you ever registered with an Armed Forces GP

  • Footnote: 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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  • NHS Organ Donor registration

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  • Please tell your family you want to be an organ donor. If you do not want to be an organ donor, please visit www.organdonation.nhs.ul or call 0300 123 23 23 to register your decision.

  • NHS Blood Donor registration

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  • Welcome to Washingborough Family Practice. It is in the interest of both yourself and your doctor that you fill this questionaire to the best of your knowledge.

  • Women Only

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  • SMS Messaging

    This is to confirm that I give consent for the Surgery to send text messages to my mobile phone. These textswill be to remind me of future appointments and for health matters relating to my treatment.I am aware that if I change my mobile phone number, it is my responsibility to inform the surgery.

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  • Your Nominated Pharmacy

    We can send your prescriptions electronically to a Pharmacy of your choice, please let us know your preferredPharmacy to enable us to do this.

  • Patient Record Sharing Preferences Consent Form

  • Please make sure you read the enclosed information sheet for patients prior to signing this form.


    Sharing out means that any information that we have recorded at our practice (all consultations, results, medication etc.) will be available for other NHS organisations to see if you allow them to. (You will be asked for your consent for this) . This will make all information added at Washingborough Surgery sharable, and we will be unable to keep any of your information confidential to the surgery.

    You can always change your mind, but if you have chosen to share information with other NHS organisations and then decide against it we cannot retrieve any information already shared.

    If I choose to make any information from Washingborough Surgery shareable, I understand this means that ALL information recorded at Washingborough Surgery will be available for other NHS services to view.

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    Sharing in means that Washingborough Surgery will be able to see all information added by other healthcare organisations. This will only happen if you have consented to share information out at the other organisations.

    I do/do not wish to allow Washingborough Surgery to view information added at other healthcare organisations.

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