Junction Surgery - New Patient Questionnaire

To register at the Junction Surgery we ask that you complete this form along with a 'Family doctor services registration (GMS1)' form.

Once completed we will need to see proof of identification and so ask that you attend one of our surgeries with this.

Your registration will not be completed until we have verified your identity and have received completed forms.

Last Updated: 12/01/2024

Proof of Identity and Address Provided

About you

Ethnicity and main spoken language

Since 1 April 2006 the Department of Health has asked that we record the ethnic origin of all newly registered patients. In certain clinical circumstances this information can be of help to doctors in providing you with more appropriate care.

Address and contact details

Next of Kin

Previous address and doctor

Additional information



Other important things to know

Share for You

As of December 2018 all GP records will be available to view, to other health and social care professionals outside the GP surgery directly involved in your care. For more information please visit: hmrshareforyou.nhs.uk


Named GP

At the Junction Surgery, all of our patients have been registered to a named GP partner and they will be the GP with this responsibility. If you do not know who your registered GP is, please feel free to contact the surgery and a receptionist will be happy to inform you. You may continue to request to see any of our GPs for your appointments and so you should see no change in the day to day running of the practice or your care.

Medical Information

Family History

Alcohol AUDIT-C (Part 1)

Alcohol AUDIT-C (Part 2)

Summary Care Record preferences form

Information about Summary Care Records

You can find information about Summary Care Records using the below links:

SCR - Information for patients

NHS Care Records

NHS Care Records Services Information Line on 0300 123 3020

Opting out

If you wish to opt out of having a summary care record, please complete the linked form and send to us.

Summary Care Record Opt Out Form


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