Forms

On this page you can find all the forms available on the website.

New Patient Registration Form

Use this form if you would like to register as a new patient at either Felmores Medical Centre or Long Riding Surgery.  Further information on registration can be found on our New Patients Page.

Child Registration Form

If you have a child/young person under the age of 18, use this form to register them at either Ballards Walk Surgery or the Gore Surgery.  Please note if you are registering a child, you must also be a patient of the practice.  Further information can be found on our New Patients Page.

Repeat Sick Certificate Request Form

Use this form if you have been unwell for more than 7 days. Further information, including what to do for self-certification, can be found on our Sick Notes Page.

Register as a Carer Form

Use this form if you are a carer for a close friend or family member.  Further information can be found on our Carers Page.

Updating Personal Details Form

Use this form if some of you information has changed since originally registering with the practice.  This could be your name, address, or contact details.  For further information visit our Patient Record Page.

Travel Assessment Form

Use this form if you are due to be travelling abroad and require vaccinations. Further information can be found on our Travel Advice Page.

Access to Medical Records

You can access your medical records online through our Patient Record Page. If you need them for a specific reason please use one of the forms.

PPG Sign Up Form

Use this form if you would like to become part of out Patient Participation Group.  Further information can be found on our Patient Participation Group Page.

PPG Comment Form

Use this form if you would like to put forward a comment or suggestion to be discussed at an upcomng PPG meeting.  Further information can be found on our Patient Participation Group Page.

Private Service Request Form

Use this form if you need to request a private service that is not included on the NHS.  Further information can be found on our Non-NHS Services Page.

Blood Pressure Monitoring Form

Use this form to monitor your blood pressure at home, or if a clinican has requested a blood pressure check.  Further information, including on home blood pressure machines, can be found on our Blood Pressure Monitoring Page.

Complaint Form (Printable)

Use this form if you would like to make a complaint about the practice or the service you have received. Please enclose it in an envelope and address it to the Practice Manager, to ensure privacy. Further information can be found on out Comments & Complaints Page.