formerly Wootton Vale & Shortstown Surgery

New Patient Registration

The partners welcome new patients who live within our practice area.

Register With Us

To register with us, please check you live within our catchment area; you can do this using the map below.

Once you have ensured you live within our boundary, please complete the online ‘New Patient Registration’ form. If you are outside our boundary, please see the section below If you are outside our boundary

The Vale Medical Practice is one practice but we have two surgery locations – Wootton and Shortstown. When you register with us, you can attend either site.

The service is designed and run by the NHS, so your personal information is safe. It cuts our administrative workload and makes it easier for you to register.

Registration forms are also available on request from Reception at the Practice.

If you would like to check whether you are resident within our Practice area then please enter your postcode below.

Practice Area

If you are outside our boundary

if you are outside the practice area, and wish to join the practice please complete the form below. Applications will be reviewed on a case by case basis. If you register from outside our practice boundary, you do so on the understanding that home visits cannot be provided.

Registration Form (Adult)

New Patient Registration Form

Please Note: A supporting signed letter from the patient will be required either posted or emailed to the practice, to complete the registration.

1. Background Details

Contact Details

Address
Address
Postcode
City
Country
Previous Address
Previous Address
Postcode
City
Country

I consent to be contacted* by SMS on this number

I consent to be contacted* by email at this number

Next of Kin

Has the Patient been registered in the NHS before?
* It is your responsibility to keep us updated with any changes to your telephone number, email & postal address. We may contact you with appointment details, test results, health campaigns or Patient Participation Group details. If you do not consent to being contacted by SMS or Email, please tick here:

Other Details

Previous GP

Address
Address
Postcode
City
Country
Ethnicity
Overseas Visitor
Armed Forces

Communication Needs

Language

Do you need an interpreter?

Communication

Do you have any communication needs?
Please specify below

Learning disability

Do you have a Learning Disability?

(If yes please request a Learning Disability Screening Tool form)

Carer Details

ARE YOU a carer?
Do you HAVE a carer?

Your carer’s details

* Only add carer’s details if they give their consent to have these details stored on your medical record

Registration Form (Child)

New Patient Registration Form

Please Note: A supporting signed letter from the patient will be required either posted or emailed to the practice, to complete the registration.

1. Background Details

Your Child’s Details

Address
Address
Postcode
City
Country

Parent or Guardian Details

Address
Address
Postcode
City
Country

I consent to be contacted* by SMS on this number

I consent to be contacted* by email at this number

* It is your responsibility to keep us updated with any changes to your telephone number, email & postal address. We may contact you with appointment details, test results, health campaigns or Patient Participation Group details. If you do not consent to being contacted by SMS or Email, please tick here:

Other Details

Previous GP

Address
Address
Postcode
City
Country
Ethnicity
Overseas Visitor
Armed Forces

Communication Needs

Language

Do you need an interpreter?

Communication

Do you have any communication needs?
Please specify below

Learning disability

Do you have a Learning Disability?

(If yes please request a Learning Disability Screening Tool form)