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Complete this form for a patient living in a care home to temporarily join our surgery and our Care Home Assessment Team.
You must complete one form per person.
Last Updated: 16/10/2023
Nominate a Pharmacy
Our prescriptions are now signed, sent and processed electronically. Prescriptions are sent electronically to your nominated pharmacy.
You will need to nominate a pharmacy.
Use the NHS 'Find a Pharmacy' tool to choose your preferred pharmacy:
Find a pharmacy - NHS (www.nhs.uk)
NHS Organ Donor
All adults in England are now considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the excluded groups.
If you would like to opt-out or to learn more please visit:
Our Privacy Notice, Data Sharing Policy and Options
Before completing this section, please read our Privacy Notice and Data Sharing Policy. These give you more information on:
You can view the Privacy Notice and Data Sharing Policy on our website:
By submitting your data online via our encrypted process, you are giving us permission to register you as a patient. We only use your information to set you up as a new patient. Once your application is complete, a PDF version will be added to your notes and the form deleted from our online contact form system.
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