How Do I....
Register With The Practice?

Please enquire at reception on how to register with the practice.

Please note that the practice does not discriminate against any person on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

At Sterndale Surgery we are open for registration and welcome new patients. Please click on the links below to download the two forms required for registration (please ensure all section on the forms are completed). If you are unsure about anything please contact the surgery to speak to one of our reception staff.

Click to download the GMS1 Registration Form.pdf
Click to download the New Patient Registration Form.doc

Patient Information

Dear Patients, we are in the process of updating our records, and would therefore be grateful if you would kindly complete the form below. This will ensure that we have your most recent and up-to-date information.

Name:
Date Of Birth: DD/MM/YYYY
Address:
Telephone No:
Mobile:

Smoking Status

Dear Patients, we are in the process of updating the smoking status of all our patients, and would therefore be grateful if you would kindly complete the form below.

Name:
Date Of Birth: DD/MM/YYYY
Smoking Status:	Please Select Current Smoker Ex-smoker Never Smoked
Quit Date:
(If ex-smoker please provide your quit date)
Quantity:
(If current or ex-smoker, please provide the number you smoke(d) daily)

Height & Weight

Dear Patients, we are in the process of updating the Height & Weight status of all our patients, and would therefore be grateful if you would kindly complete the form below.

Name:
Date Of Birth: DD/MM/YYYY
Height:
Weight: