Mayfield Medical Centre

Join The Practice

We welcome new patients. You are able to register in person by calling in person at any time during opening hours when you will need to complete the registration form as well as the New Patient Questionnaire. We ask you to bring in proof of ID (eg. passport, birth certificate or drivers license) as well as proof of residence for security reasons.

Alternatively you can register online by using the form below. We will then send you a New Patient Pack.

We offer a double 20 minute appointment on your first visit for the GP to get an overview of your medical history as well as you getting to meet your doctor.

Please note, we will never pass your personal details on to any third parties. Your privacy is very important to us.

Please complete the following form

Your Details

• Title: Mr Mrs Miss Ms Dr
• First Name:*
• Surname:*
• Date Of Birth:*
  • Day --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
  • Month ----- January February March April May June July August September October November December
  • Year ---- 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910
• Your Town & County of Birth:*
• Ethnicity:

Address & Contact Details

• House no. & Street Address:*
• Town / City:
• Post Code:*
• Telephone Number:
• Mobile Number:
• Email Address:*

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

Previous Details (if applicable)

• Previous Surname / Maiden Name:
• Your previous address in the UK:

Previous Doctors Details

• Previous Doctor:*
• Previous Doctors Address:*

Further Information

Please help us by providing the following details:

Have you recently moved from abroad?:

• No
• Yes

Residency Information

• Your first UK address where registered with a GP:
• If previously resident in UK, date of leaving:
• Date you first came to live in the UK:

Have you returned from the Armed Forces?:

• No
• Yes

Service Information

• Address before enlisting:
• Service Personnel Number:
• Enlistment Date:

Would you like to join the NHS Organ Donor Register?:

• No
• Yes

Yes, I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my death. Please tick as appropriate

I would like to donate my

• Kidneys
• Heart
• Liver
• Corneas
• Lungs
• Pancreas
• Any part

NHS Organ Donor Register

New Patient Questionnaire

New patients registering online are required to download and complete the 'New Patient Questionnaire' form.

The 'New Patient Questionnaire' form will give our doctors an idea of your previous medical history, so it is very important that you bring this form with you on your first visit to the surgery.

Download the New Patient Questionnaire

I have downloaded & completed the New Patient Questionnaire form

Please complete our anti spam check:

What Happens Next?

On receipt of your completed application, we will send you a New Patient Pack which will give you further details on the practice.