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 need to see anyone over the age of 16 with their ID.
****** IF YOU DO SUBMIT YOUR REGISTRATION ONLINE, PLEASE BRING YOU ID INTO THE PRACTICE WITHIN ONE MONTH OF REGISTRATION, THIS WILL ENABLE THE PRACTICE TO PROCESS YOUR REGISTRATION IN A TIMELY MANNER*****
During the Covid-19 pandemic it is not necessary to bring in ID for Registration to the Surgery, but you will need it for the Online Service.
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
If you wish to Register click on the links below to open the forms. When you have completed all of the details, click on the "Send" button to mail your GP Surgery Registration Form to us and then e-mail to firstname.lastname@example.org the relevant New Patient Health Questionnaire and Online Service Agreement if required. When you visit the surgery for the first time you will be asked to show us some identification such as a driving licence or passport. Without the 2 forms of identification requested on the form, we will not be able to complete your registration for the Online Service
E-mail/post/drop in the following forms to the Surgery:-
New Patient Health Questionnaire - Adults
New Patient Health Questionnaire - Child
New Patient Health Questionnaire - Newborn (up to 2 months)
Access to Online Service Agreement - Over 16 years
Access to Online Service Agreement - Under 16 years
Accessing Online Services 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