Peverell Park Surgery & University Medical Centre

Peverell Park Surgery & University Medical Centre

Peverell Park Surgery, 162 Outland Road, Plymouth, PL2 3PX. Telephone: 01752 766644 | University Medical Centre: 01752 222341

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NHS

Telephone: Peverell Park 01752 766644 University Medical Centre 01752 222341

administration.peverellpark@nhs.net

New Patient Registration

We are able to register patients within our Practice Boundary. If you would like to register with the practice please use the web form below or click GMS1-family-doctor-services-registration-form to print-out a copy to fill in manually.

We require your previous medical records before prescribing regular medication. Therefore please ensure you have a month’s supply of regular medication from your previous surgery before registering.

Please read our Data Sharing Information page before completing the form.

 

New Patient Registration Form

  • Patient details

  • Please include house name and/or number. If you are a student attending Plymouth University, please enter your University address.
  • We will not leave detailed messages on your phone, but may ask you to contact us or leave a simple mesage if we do not need to speak to you.

  • Ethnicity

  • Emergency Contact

  • Allergies

  • Previous Details

  • If you are from abroad

  • Once you have completed your online registration and it has been processed by our team you will receive an email asking you to reply with a photo of your BRP card. This will be deleted from our email account after 21 days.

  • If you are returning from abroad

  • Previously been a resident in the UK

  • Supplementary Questions

  • European Economic Area (EEA) Country

  • Click here for a list of EEA countries

    Please give your S1 form to the practice staff.
  • How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process. Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

  • If you are returning from the Armed Forces

  • If you are returning from the Armed Forces please complete our HM Forces Patient Form

  • If you are registering for a child under 5

  • If you need you doctor to dispense medicines*

  • *Not all doctors are authorised to dispense medicines

  • Mobility

    (Definition of housebound - A patient is unable to leave their home due to physical or psychological illness)
  • Carers

  • Lifestyle

  • If yes to either of the above questions, please ensure you provide the practice with a copy of this so that this can be documented on your medical notes.

  • If you would like advice on managing a healthy weight, please contact https://www.nhs.uk/live-well/ or reception who will be able to direct you to the most appropriate service.

  • If applicable
  • If you would like help and advice on how to give up smoking, please visit www.nhs.uk/smokefree

  • If applicable
  • If applicable
  • Alcohol Consumption

  • If you would like help and advice on how to give up reduce your alcohol intake, please visit www.drinkaware.co.uk

  • Immunisation History

  • Please include dates
  • Medical History

  • Please include dates
  • Please include dates
  • Please include dates
  • Over 75 years old?

  • The Department of Health has advised that all patients of 75years and older have a named and accountable GP to oversee their care. Please ask the name of the GP assigned to oversee your care. Please note this does not prevent you from seeing the GP of your choice.

  • What happens to my information?

  • What happens to my information? Personal and medical information about patients registered at this practice are primarily kept electronically, although some is kept in paper form. Some information will be sent to hospital consultants and other health professionals to whom you are referred by your GP in order to provide continued healthcare and obtain treatment for you. We sometimes use accredited suppliers for our communication with you, for example when we send recall letters for review clinics or medication reviews. All suppliers we use are checked carefully to ensure they comply with strict confidentiality protocols. To ensure the security of all patient information, all staff that has access to your records is covered by confidentiality clauses in their contracts and the Data Protection Act and the Freedom of Information Act. Our guiding principle is that we hold your records in strict confidence. I certify that the information I have provided is correct and consent to my personal and medical information being used as stated above.

  • Summary Care Record

  • A Summary Care Record (SCR) includes important information about your health: medicines you are taking, allergies you suffer from and any bad reactions to medicines. Having a SCR means that when you need healthcare you can be helped to recall vital information. SCRs can help the staff involved in your care make better and safer decisions about how best to treat you. You can choose to have additional information included in your SCR such as: your illnesses and health problem, operations and vaccinations you have had in the past, how you would like to be treated - such as where you would prefer to receive care, what support you might need, who should be contacted for more information about you which can enhance the care you receive.

  • Service Families and Military Veterans

  • As a practice, we fully support the Armed Forces Covenant. We can only do this if we know our patients connections to the Armed Forces. Please tick below boxes that apply to you:

  • NHS Organ Donor registration

  • For more information on organ donation please visit: www.organdonation.nhs.uk

  • NHS Blood Donor registration

  • If you would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood, please visit their website on: www.blood.co.uk or call direct on 03001232323

  • This field is for validation purposes and should be left unchanged.