Mental health awareness week
10-16 May 2021. Find out more

New Patient

Fill in form below to register as a new patient. A member of the team will be in contact with you shortly.

New Patients
PLEASE NOTE: If you take any regular medications, you will need to provide a copy of your current repeat prescription slip in order to continue to receive them. Electronic prescriptions are the safest way to deal with your medication. Do you wish us to nominate The Ridge Pharmacy for all your electronic prescription? *
Title *
Were you ever registered with an Armed Forces GP – please indicate if you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas:

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.

NHS Organ Donor registration I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death. Please tick the boxes that apply
NHS Blood Donor registration I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood
Are you currently pregnant? *
I wish to have access to the following online services (please select all that apply):
Maximum upload size: 2.1MB
Disability – tick all that apply *
Are you a Carer? *
Do you have a Carer? *
Ethnicity – tick 1 box *
Smoking status – tick one box only *
Do you drink alcohol? *
If yes, please answer 3 questions below
How often do you have a drink containing alcohol?
Hoe many of units of alcohol do you drink on a typical day when having a drink?
How often have you had 6 or more units if female or 8 or more units if male, on a single occasion in the last year?
How much exercise do you consider yourself as doing?

Important Information – Please read before returning this form

You can now use the internet to book GP appointments and request your repeat prescriptions. You can also view your medical record.

It will be your responsibility to keep your login details and password safe and secure. If you know or suspect that your record has been accessed by someone that you have not agreed should see it, then you should change your password immediately.

If you can’t do this for some reason, we recommend that you contact the practice so that they can remove online access until you are able to reset your password.

If you print out any information from your record, it is also your responsibility to keep this secure. If you are at all worried about keeping printed copies safe, we recommend that you do not make copies at all.
Before you apply for online access to your record, there are some other things to consider.

Although the chances of any of these things happening are very small, you will be asked that you have read and understood the following before you are given login details.

Forgotten History

There may be something you have forgotten about in your record that you might find upsetting.

Abnormal results or bad news

If your GP has given you access to test results or letters, you may see something that you find upsetting to you. This may occur before you have spoken to your doctor or while the surgery is closed and you cannot contact them.

Choosing to share your information with someone
It’s up to you whether or not you share your information with others – perhaps family members or carers. It’s your choice, but also your responsibility to keep the information safe and secure.

Coercion

If you think you may be pressured into revealing details from your patient record to someone else against your will, it is best that you do not register for access at this time.

Misunderstood information

Your medical record is designed to be used by clinical professionals to ensure that you receive the best possible care. Some of the information within your medical record may be highly technical, written by specialists and not easily understood. If you require further clarification, please contact the surgery for a clearer explanation.

Information about someone else

If you spot something in the record that is not about you or notice any other errors, please log out of the system immediately and contact the practice as soon as possible.

DISCLAIMER

The Ridge Medical Practice cannot be held responsible for text messages sent to a mobile telephone number you have provided which no longer belongs to you or if someone has access to your mobile and can view your messages. We further recommend you do not smoke, drink alcohol within national guidelines and exercise regularly.

I wish to access my medical record online and understand and agree with each statement below:
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