Online 'Pre-Registration' With The Practice

PreRegistrationIf you wish to pre-register click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. When you visit the surgery for the first time you will be asked to sign the form to confirm that the details are correct.

Please could you also answer the medical questionnaire belowYour registration will not be processed until we receive both the pre-registration form and the medical questionnaire for each patient wanting to be registered with us.

Dr Wilcox is currently the named GP for new patients registering with Lightwater Surgery.

Pre-registration Form

Online Medical Questionnaire For New Patients

Please complete any relevant sections on behalf of your children. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too, which you may fill out and send to us. When you come to the surgery you will be asked to sign this form to confirm that the details are correct.  We may be in contact if we require any further information.

Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.

Alternatively you may print off a registration form, fill it out and bring it in with you on your first visit to the practice.  We also require you to complete a medical questionnaire in order to complete your registration.

pdfRegistration Form

New Patient Questionnaire - Adult

Child New Patient Questionnaire (Ages 0-16)

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