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Registration

We accept patients from the St Agnes and surrounding areas including Mount Hawke, Porthtowan, Blackwater and Perranporth.

Please complete all the forms listed below to make registration easier.

Please complete all the forms and bring them into the surgery with a form of ID; this can be a driving licence or passport. We do need to see anyone over the age of 16 with their ID.

Should you wish to make an appointment or order repeat medication on-line, please could you also complete the on-line services application form:

On Line Registration with the practice

Pre-registrationIf you wish to pre-register click on all links below to open the forms. 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 and show us some identification such as a driving licence or passport.  Without this identification we will not be able to complete your registration

GP Surgery Registration Form

Online medical questionnaire for new patients

Patient on-line Services Application Form

Under 16 On-Line Services Application Form

Ethnic Origin Form

Alcohol Intake


Download our Practice Leaflet

Large Print Practice Leaflet


When you register you will also be asked to fill out a medical questionnaire. 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.

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.

Change of Address

Please let us know as soon as possible if your address changes to enable us to keep our records up to date..

You may use the online form below to notify us of your change of details. You will need to print out the form and send it in to the surgery. Alternatively please pick up a paper form at the practice. You need to make sure all members of the family are included on the form.

Change of Name and Address Form.doc

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