Radcliffe Medical Practice

Secondary telephone

New patient registration

IMPORTANT: Please complete the form in as much detail as possible. We cannot process your registration without all the relevant information and this will delay you accessing practice services.

  • Patient's details

  • DD slash MM slash YYYY
  • Please let us know whether you consent to receive notifications from the practice via SMS or email.
  • Please help us trace your previous medical records by providing the following information

  • If you are from abroad

  • Were you ever registered with an Armed Forces GP

  • DD slash MM slash YYYY
  • MM slash DD slash YYYY
  • Footnote: These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.
    *Not all doctors are authorised to dispense medicines
    Please tell your family you want to be an organ donor. If you do not want to be an organ donor, please visit www.organdonation.nhs.uk or call 0300 123 23 23 to register your decision.
    I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood.
  • All blood types are needed, especially O negative and B negative. Visit www.blood.co.uk or call 0300 123 23 23.
  • Personal Details

  • Asian or Asian British
  • White
  • Mixed
  • Chinese or Other ethnic Group
  • Black or Black British
  • Please give names and contact number of all people who have legal parental responsibility for the child. (Usually the child's biological/adoptive parents)