New Patient Registration Adult Form

Last Updated: 24/11/2023

Patient details

Information about you

If you did not wish to disclose this information please say this in the text box below

Consent to contact

Contact Preference

Next of Kin

Your next of kin details are requested so we are able to contact a family member or friend if you are needing assistance at the surgery.


Third Party Consent

Your third party contact will be someone who can organise appointments on your behalf, collect prescriptions or fit notes and discuss your care with a clinician. Please be advised that your next of kin and third party are listed separately as they will have different permissions on your medical file.

Please note once a patient reaches their 16th birthday, they will need to complete a consent form in order for their third party contact to discuss care with a clinician, on behalf of the patient. This includes immediate family members.

Nominated Pharmacy

Where would you like to collect your prescriptions?

Record Sharing

This GP practice is able to share your electronic GP record with healthcare professions caring for you elsewhere e.g. in community, hospital or urgent care services. This may help in your care and may save you from needing to remember your medical history and medications. This surgery uses a computer system called SystemOne that allows the sharing of full electronic records across different health services if patient consent is given. There are two ways in which your information can be shared.

Sharing Out - This controls whether your information entered at this surgery can be shared with other NHS services

Sharing In - This controls whether information that has been made shareable at other NHS services can be viewed by the surgery

Access to System On Line and NHS App

This will provide you access to request ongoing medication, to book some clinician appointments and access to prospective Full Record Access

Please help us trace your medical records by providing the following information

If you are from abroad

Please note that if you have not been registered with a GP Practice before and were not born in the UK we will need the date you came to the UK to be able to register you.

Were you ever registered with an Armed Forces GP?

Medicines and Appliances

*Not all doctors are authorised to dispense medicines

Medical Information



Routine HIV Testing at Park Crescent

HIV (Human Immune-Deficiency Virus) is a virus which attacks the body's immune system, making it difficult to fight infections. The only way to identify the people affected is to encourage everyone to have a HIV test. 

We offer routine HIV tests on all our patients as recommended by the Department of Health, either on registration or as part of routine care. This is because:

  • It is best practice and recommended nationally
  • Brighton and Hove have the highest levels of HIV in the country, outside of London
  • Around a quarter of people with HIV do not know that they have it because they have not taken a test
  • HIV can now be treated very successfully with medication which can keep people healthy and well and prevent further transmission.

Please book an appointment if you would like to take a test, or let the clinician know at any routine blood test appointments.


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