Registering Online

If you wish to Register with our surgery you will need to complete both the Pre-Registration Form and the Online Medical Questionnaire for New Patients.  Please click on each of the two links below to open the forms. When you have completed all of the details, click on the "Send" button for each to mail your forms to us. Please note we will not be able to register you unless both forms are completed.  When you visit the surgery for the first time you will be asked to sign the form to confirm that the details are correct, and provide a copy of your identification. 

Please note that it can take up to five working days for registrations to be completed.

Pre-registration Form

When you register you will also be asked to fill out a medical questionnaire. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too, which you may fill out and send to us. When you come to the surgery you will be asked to sign this form to confirm that the details are correct.

Online Medical Questionnaire For New Patients

Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.

New Patient Registrations

The map below gives you an indication of the area's we cover as a Practice.  We only cover the white area, any areas in or outside the coloured area are not covered by our Practice as they have a Practice which is closer to them where they can register.  These area's include Great Notley, Silver End, Gosfield, Beazley End, Great Saling and Shalford.  If you have any questions regarding the area please do not hesitate to contact our reception team who will clarify for you.