Join The Practice

We welcome new patients living within our practice area and who wish to join us.

Our practice catchment area covers all of Golders Green which is the NW11 postcode of London, some of NW4, and some of NW9. Some exceptions may be made for patients living very close to our boundaries. Contact us if you are not sure. Please provide proof of address so that we can check your residence is within our area

Join The Practice Request

To register online please ensure that you complete all fields on both the new patient registration form and the health questionnaire that follows once you click ‘submit’.

Please ensure to fill in your Previous address on GP so we are able to trace your medical records.

Registrations will be processed within 5 working days

Patient’s Details

Health Questionnaire

Online Access

Patient’s Details

Title: *

Please Specify

First Name(s) *

Middle Name

Last Name *

Previous Surname(s)

Sex: *

Is your gender identity the same as the sex you were registered at birth? *

Marital Status *

Date of Birth *

Town and country of birth *

Home Address *

Postcode *

Phone Number *

Alternate Number

Email Address *

Occupation

Please provide a mobile telephone number wherever possible. By doing so, you will be automatically enrolled to our text reminder service. We will use this for: contacting you about your health when unable to contact you at home / texting your appointment reminders / responding to your queries / advising when your prescriptions/paperwork is ready / advising you if appointments are cancelled.

To opt out of our text message reminder services please tick here

To opt out of our text messaging for test results please tick here

To opt out of receiving emails from us, please tick here

Parent/Guardian/Carer

Is your Parent/Guardian/Carer currently registered or in the process of registering, at the practice? *

Please enter your Parent/Guardian/Carer details below:

Full Name *

Date of Birth *

Email Address *

Student

Are you currently a student?

Previous Details

Were you ever registered with a GP practice in the UK? *

NHS Number

Find your NHS Number

Your previous address in UK *

Please include postcode.

Name and address of previous GP Practice *

Abroad

Are you coming or returning to U.K. from abroad?

Your first UK address where registered with a GP

If you have only ever lived at one address please enter the same address here.

If previously resident in UK, date of leaving

Date you first came to live in UK *

Armed Forces

Are you returning from the armed forces?

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:

Address before enlisting

Service or Personnel Number

Enlistment Date

Discharge date (if applicable)

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

Organ donation in England has moved to an 'opt out' system. This means that all adults in England will be considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the excluded groups.

You still have a choice about whether or not you wish to become a donor. If you wish to know more on the law and Opt Out from the register, please visit NHS Organ Donation.

NHS Blood Donor Registration

You can self-register on the NHS Blood Donor Register, if you wish to become a blood donor. Please visit the website to register.

Supplementary Questions

I am not ordinarily resident in the UK

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. Alternatively for more information go to www.nhs.uk/visitingengland

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

Please tick one of the following boxes

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate action may be taken against me.

Signature

Type your full name

A parent/guardian should complete the form on behalf of a child under 16.

On behalf of

Relationship to Patient

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea

Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?

EHIC OR PRC

Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) ?

Please enter the details from your EHIC or PRC below.

Country Code

Name

Given Names

Date of Birth *

Personal Identification Number

Identification number of the institution

Identification number of the card

Expiry Date

PRC validity period - from

PRC validity period - to

S1 Form

I have an S1 form (e.g. you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state).

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.

Carers

It’s important that everyone who works here at Ravenscroft Medical Centre knows you are a carer so that we can offer you help and support if you need it. Anyone who looks after a friend or family member who cannot manage without them, and is unpaid, can register. This includes carers under the age of 18.

Are you cared for by someone?

Name of carer

Relationship to carer

Address and contact details of carer

Do you care for someone?

Full name of person cared for

Relationship to person cared for

Please complete the Carer Information Form, to get your details added to your medical records.

Emergency Contact Details

Emergency Contact Details *

Full Name *

Phone Number *

Address *

Relationship *

Patient Participation Group

We have a patient participation group who meet with the practice on a quarterly basis. This group provides an effective way of patients and the surgery working together to improve services and to promote health and improved quality of care.

If you are interested in joining the group, please complete the Patient Participation Group Registration Form.

Ethnic Group

In compliance with the Race Relations (Amendment) Act 2000 and its Race Equality Scheme any new patient registrations are requested to complete this form.

Which of the following best describes your ethnic background? *

Please Specify

Main Language Spoken *

Do you need an interpreter?

Religion

Social Services

Have your previously or currently receiving support from social care?

Please specify

LGBTQ+

Do you identify as a member of the LGBTQ+ community?

NHS App:

We are asking all new patients who register with us to download the NHS App to enable you to:

Renew repeat prescriptions
Book and manage appointments
Securely access your medical records
Check your symptoms, get instant advice, and more

Please tick this box to be emailed your PIN

Please tick if you need online access to medical records

Please note – The medical records will be from the date of registration

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.

The information that you can see online may be misleading if you rely on it alone to complete insurance, employment or legal reports or forms.

Be careful that nobody can see your records on screen when you are using Patient Online and be especially careful if you use a public computer to shut down the browser and switch off the computer after you have finished.

There are a few things you need to think about before registering for online records. On very rare occasions:

Your GP may not think it in your best interest for you to look at your GP records online. If this happens, your GP will discuss their reasons with you. It is up to your GP to decide if you should be allowed access to your online records.
You may see your test results before your doctor has spoken to you about them. This may be when you cannot contact your surgery, or when your surgery is closed. This means you will need to wait until an appointment is available to talk to your doctor.
Information in your medical records might need correcting. If you find something you think is not correct, you should contact your surgery. The staff will be able to answer your questions and set things right when needed. Please bear in mind that you cannot change the record yourself.
There may be information in your medical records that you did not know was there or that you had forgotten about, such as an illness or an upsetting incident. If you see anything you did not know about that worries you, please speak to your surgery and they will discuss this with you.
If you see someone else’s information in your record, please log out immediately and let your surgery know as soon as possible.
If you have questions about any of the above points, please talk to your surgery and they will be able to advise you further

Care Data and the NHS Digital

Confidential information from your medical records can be used by the NHS to improve the services offered so we can provide the best possible care for everyone.

This information, along with your postcode and NHS number but not your name, are sent to a secure system to be linked with other health information. This allows those planning NHS services or carrying out medical research to use information from different parts of the NHS in a way which does not identify you.

Opt out: Please find out more on NHS Digital Data Collection and the Opt-Out process on NHS Digital Website.

Summary Care Record for Children

Care professionals in England use an electronic record called the Summary Care Record (SCR). This can provide those involved in your care with faster secure access to key information from your GP record.

Core Information:

If you are/have been registered with a GP practice in England, you will already have an SCR unless you have previously chosen not to have one. It includes your name, address, date of birth and unique NHS Number which helps to identify you correctly. The core SCR holds information about, medicines you are taking, allergies you suffer from; any bad reactions to medicines.

Additional Information:

Your SCR can include more information such as significant medical history (past and present), information about management of long term conditions, immunisations and patient preferences such as end of life care information, particular care needs and communication preferences. You may have personal preferences, such as religious beliefs or legal decisions that you would like to be known and these can be held in your SCR.

Specific sensitive information related to fertility treatments, sexually transmitted infections, pregnancy terminations or gender reassignment will not be included, unless you specifically ask for any of these items to be included.

Essential details about your healthcare can be very difficult to remember, particularly when you are unwell. Having information in your SCR means that when you need healthcare, you will be helped to recall this vital information. There are already clear benefits for patient care from having medication, allergy and adverse reaction information available through SCR. If you choose to have this information in your SCR, this can further increase the quality of your care.

Additional information can also empower you if you need some help to communicate your complex care needs.

Only authorised care professional staff in England who are involved in your direct care can have access to your SCR. Your SCR will not be used for any other purposes. These staff will only see the information they need to do their job, and their details will be recorded every time they look at your record to ensure it is appropriate.

If you are the parent or guardian of a child under 16 you need to provide consent in relation to their records. If you feel they are able to understand this information you should show it to them to support them in coming to a decision about having the information in their SCR.

Name of Child/Children

Relationship to child/children

For more information on Summary Care Record, please click here.

If you don’t select an option above, we will record this as Implied consent for for Core Information.

Online Declaration

If you are happy with the information provided for online access to your medical records please tick the boxes below and sign and date your acceptance for online access.

For patients aged 16 years and over

I have read and understood the information leaflet provided by the practice registration form

I will be responsible for the security of the information that I see or download

If I choose to share my information with anyone else, this is at my own risk

I will contact the practice as soon as possible if I suspect that my account has been accessed by someone without my agreement

If I see information in my record that is not about me or is inaccurate, I will contact the practice as soon as possible

Signature

Type your full name

Proxy Access

What is a proxy? Proxy access allows parents, family members, carers, care home staff, to have access to their patients’ online services accounts, in order to book appointments, request repeat medication and where applicable, view their medical record.

Patient’s over 16 years of age are usually deemed competent to manage their own accounts. If you are over 16 and wish to allow a proxy to have access to their account then please supply their details. If no details are supplied then you will be given the on line access. When you, the patient, reaches 16, then your proxy’s access to your account will automatically be removed from the clinical system.

Patients below the age of 16 can have access to their own records but the practice needs to review this and this will need discussing with a GP following the patients registration.

Do you wish to give consent for Proxy Access to someone else?

Please provide the proxy user’s details:

Full Name *

Date of Birth *

Email Address *

Access to Medical Records? *

On what basis is this proxy access being requested? *

Proof of ID and Address

You must provide one proof of identify (ID) and one proof of address (POA) from the approved list

Please note - the practice will be unable to accept you unless you provide the 2 forms of identification as requested.

Drag & Drop files here or click to browse

Upload

Acceptable file formats are JPG, PNG OR PDF. The file size should not exceed 3MB.

Feedback

How did you hear about us? *

I confirm to have checked my postcode to be within the practice boundary *

I want a copy of the contents of this form to be emailed to me

FAQ's

What are the acceptable examples of Photo ID and Proof of Address?

Acceptable photo ID:

Current passport or identity card
Resident permit issued by Home office
Current UK photocard driving licence
HM Forces identity card
Police photographic ID card
University or college photo smartcard
NHS smart card

Acceptable proof of address:

Recent utility bill (within 3 months of the current date)
Local authority tax bill ( valid for current year)
Bank or building society statement ( within 3 months of a current date)
Current tenancy agreement
Court order (within 12 months of the current date)
UCAS letter (within 12 months of the current date)

What is temporary registration?

If you are ill while away from home or if you are not registered with a doctor but need to see one, you can receive emergency treatment from the local GP practice for 14 days. After 14 days you will need to register as a temporary or permanent patient.

You can be registered as a temporary patient for up to three months. This will allow you to be on the local practice list and still remain a patient of your permanent GP. After three months you will have to re-register as a temporary patient or permanently register with that practice.

To register as a temporary patient simply contact the local practice you wish to use. Practices do not have to accept you as a temporary patient although they do have an obligation to offer emergency treatment. You cannot register as a temporary patient at a practice in the town or area where you are already registered.

Download the Temporary Residents Registration Form

What if I live outside the practice area?

Outer practice boundaries are an expansion of a GP's original catchment area. Whereas in the past you may have had to register with a new GP after moving a few streets further down the road, these outer boundaries can be a way to stay registered with your old GP.

You’ll still have to speak with your GP first and, if appropriate, the GP may keep you on the register. Please talk to your GP for more information on this.

Are my details secure?

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible.

We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. When you submit your information, it is safely transmitted over the web in an encrypted form and deciphered using the private key at its intended location.

Join The Practice