HOW DO I...
REGISTER?

Please note there are two completely separate practices working at Southwell house. To join The Puzey Family Practice please go to Windows 2 or 3 to complete the necessary forms. The receptionist will help you and will arrange a convenient time for your introductory medical examination. You will receive your new medical card through the post from Essex Health Authority after a few weeks but you will be entitled to medical care from the day you register with us. If you have any questions to ask about our practice or its services, feel free to ring us on 0845 408 1277 and speak to one of our receptionists or the practice manager.

ONLINE REGISTRATION

To register online please complete the form below-

REGISTER DETAILS   Title: Please select Mr Mrs Miss Dr Proff Other (please specify) Date of Birth: Town & country of Birth: NHS no. (if known): Are you: Male Female Surname: First Names: Telephone: Mobile: How you describe your ethnic origin? Email Address: Address:   Postcode: Are you a carer for a sick/elderly person(s)? Yes No Previous medical records Your previous address in the UK   Postcode Name of your previous doctor at that address Address of previous doctor Are from abroad? Yes No Your first UK address where registered with a GP If previously resident in the UK, date of leaving Date you came first came to the UK Are returning from the Armed Forces? Yes No Address before enlisting   Service/Personnel No.:   Enlistment date: NHS Organ Donor Registration I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my death. Yes No Please check as appropriate:- Kidneys Heart Liver Corneas Lungs Pancreas Any part of my body CONFIDENTIALITY - TERMS AND CONDITIONS: The internet is not secure, and the transmission of this data is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions. I accept the terms and conditions above On receipt of your completed application, we will send you a pack with details of our practice and contact you to organise a new patient check.