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)
  • Drug Dependence Policy - New Patients

    Drugs of Dependence Policy - New Patients A controlled substance is generally a drug or chemical whose manufacture, possession, or use is regulated by the government because of the potential for abuse or addiction. Such drugs include those classified as narcotics, stimulants, depressants, hallucinogens, and cannabis. A list of the most commonly encountered controlled drugs: Morphine, Pregabalin, Oxycodone, Gabapentin, Fentanyl, Temazepam, Buprenorphine, Nitrazepam, Codeine, Diazepam, Dihydrocodeine, Lorazepam, Tramadol, Zopiclone, Tapentadol, Zolpidem. New Patients: Please inform staff if you are prescribed any of the above medication. Some of our patients require strong, potentially addictive medication to help manage their condition(s). Of concern are ‘drugs of dependence’ (e.g. opioid medications and benzodiazepines), particularly when these are prescribed on an on-going basis. Due to increasing reports of abuse of prescription drugs Waterfoot Medical Practice has established a policy to ensure adequate treatment of your condition, while reducing the risk of problems with drug prescriptions. If you are a new patient to the practice: • It may take time to get accurate medical information about your condition. Until such information is available, your GP may choose not to prescribe any medication. It is our policy that GPs do not prescribe drugs of dependence until they have a full clinical picture. • Your GP may decide not to continue prescribing an opioid medication previously prescribed for you. It may be determined that such a medication is not suitable. It is our policy that GPs do not prescribe drugs of dependence if they feel that previous prescriptions were inappropriate. • Your GP will evaluate your condition and only prescribe an opioid of the strength necessary for you. This may be different to the drug you had prescribed at your previous GP Practice. General practice standards: • If the decision to prescribe is taken after a shared discussion of goals, plans, risks and benefits, you may be required to confirm your consent in writing. • You will be asked to complete the Opioid Management Plan: Treatment Agreement that will detail our practice’s expectations when prescribing drugs of dependence. This agreement details your responsibilities as a patient taking a drug of dependence; any prescriptions issues; advice on taking your medications; how we will monitor your care; and the standards of behaviour that are expected. • Patients may need to acknowledge that their care requirements may be complex, and that referral for on-going care for all or part of your healthcare may be required. It is our practice policy that patient care is matched with the level of complexity. • Patients are reminded that we have a zero tolerance on issues relating to staff abuse.

Date published: 14th April, 2020
Date last updated: 22nd July, 2022