GMS1 Form (Required)
Please fill out the following document and fill out the details. (You are able to type in to the PDF).
Please save as and attach below.
Click above for GMS1 form
Personal Identification (Required)
Please upload a form of personal identification. Such as your passport or drivers license.
Medical Questionnaire - Section 1: Your Details
Medical Questionnaire - Section 2.1: Ethnicity
Medical Questionnaire - Section 2.2: Smoking Screening
If you have selected 'No', please skip to section 2.3
Medical Questionnaire - Section 2.3: Alcohol Screening
If you have selected 'No', please skip to section 2.4
Please add up your score in brackets. If you score is below 5, please skip to question 2.4.
Medical Questionnaire - Section 2.4: Physical Health
Using a blood pressure machine (home or pharmacy), please take your blood pressure readings and note below. If you do not have a blood pressure machine at home, please skip this question & visit reception where we have a machine in the waiting room at your earliest convenience.
Medical Questionnaire - Section 2.5: Medical History
Medical Questionnaire - Section 2.5: Family History
Medical Questionnaire - Section 3: Cervical Smear Test (Females only)
If you would like to opt out from the cervical screening programme, please visit our website & fill out the informed consent for withdrawal form, alternatively please speak to a member of our reception team.
Medical Questionnaire - Section 4: Free NHS Health Check
We carry out NHS Health Checks on anyone who is eligible (see below). This can be considered a 'MOT' to give you guidance about your health.
You will be eligible if you meet all of the following criteria, if unsure please ask one our health advisers who will be happy to answer your questions.
You are aged 40 to 75 years old
You have NO pre-existing health conditions/chronic diseases (Diabetes, High blood pressure, High Cholesterol, Kidney disease)?
You have NOT had a NHS Health Check in the past 5 years?
If you meet the eligibility, then you are eligible for an NHS Health Check. Please inform the receptionist so an appointment can be booked with the Health Care Assistant.
Medical Questionnaire - Section 5: Electronic Prescription Service
The Electronic Prescription Service (EPS) is an NHS service. It gives you the chance to change how your GP sends your prescription to the place you choose to get your medicines or appliances from. If you want to use EPS ask someone at your GP surgery or at any pharmacy or dispensing appliance contractor that offers EPS to add your nomination for you. Nomination means you choose a place for your GP practice to electronically send your prescription to. You don't need a computer to use EPS. For more information, please visit our website.
If you have ticked yes for the Electronic Prescription Service & the nomination above is left blank, we will automatically nominate you to the closest pharmacy to your address.
Medical Questionnaire - Section 6: Online Access
At Carepoint Practice, we aim to offer everyone in our care a high quality service and therefore we have made patient access available to all our patients. This is available through the Patient.info website and as a mobile app for both Android and iOS devices,
With Patient Access, you can now access our services (mentioned below) at home, work or on the move — wherever you can connect to the internet. What's more, because Patient Access is a 24 hour online service you can do this in your own time, day or night.
If you have selected yes, you will be texted an online linkage key within 10 working days of you registering. If you have not received the text, please call reception.
Children under 11 are able to have a parent/carer as a proxy user. Patients 11-18 are required to fill out a separate authorisation form.
Medical Questionnaire - Section 7: Out of Area
If you live more than 1km away from our practice postcode, please be aware that we will no longer be able to visit you if you are unable to attend the practice. This may make it more difficult for you to access medical help when you are not well. It is not the responsibility of the practice to arrange for another doctor to visit you in these circumstances.
Should you still wish to remain registered at the practice under these terms then please complete the section below (child’s questionnaire can be completed by parents)
I wish to remain registered at the practice and accept that I will not be able to ask for a home visit at my address and that the practice will not be responsible for arranging this help for me if required
Medical Questionnaire - Section 10: Summary Care Records
Request for all clinical data to be withheld from the summary care record
What does it mean if I DO NOT have a summary care record?
Health-care staff treating you may not be aware of your current medications in order to treat you safely and effectively. Health-care staff treating you may not be made aware of current conditions and/or diagnoses leading to a delay or missed opportunity for correct treatment. Health-care staff may not be aware of any allergies/adverse reactions to medications and may prescribe or administer a drug/treatment with adverse consequences.
If you have any questions or if you wish to discuss your choices or concerns, please telephone the NHS Care Records Service Information Line on 0845 603 8510. If you remain unsure about whether or not to have a SCR please speak to reception.
I DO NOT want to share my clinical data
Please go to www.nhs.uk/your-nhs-data-matters to opt out. The GP practice can no longer opt you out.
Medical Questionnaire - Section 11: National Patient Date Opt-Out
Please go to www.nhs.uk/your-nhs-data-matters for information regarding the National Patient Data Opt-Out. You can also update your preferences on the NHS website (you will need your name, date of birth & NHS Number). The GP practice can no longer opt you out.
Thank you for submitting the online registration for Carepoint Practice. It may take us up to 5 working days to register you. If you have not heard from us by then, please call us.