Cottenham Surgery

188 High Street, Cottenham, Cambridge, CB24 8SE

Telephone: 01954 250079

Sorry, we're currently closed. Please call NHS 111 if life threating emergency please call 999

New Patients

We are currently accepting new patients.

If you are new to the Practice you will be invited to see the nurses for a health assessment, this is so that we can obtain some general information about you before your formal records are sent from your old practice.

Family Doctor Service Registration

"*" indicates required fields

Step 1 of 3

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Patient details

Title*

Date of Birth*

DD slash MM slash YYYY

Gender*

NHS Number

First Names*

Surname*

Birth Town*

Birth Country*

Current Address and Postcode*

Telephone*

Mobile*

Do you give consent to send SMS messages?*

Yes

Email Address*

Please help us trace your previous medical records by providing the following information

Have you previously been registered with an NHS GP in UK?*

Yes

Name of Previous GP*

Address of Previous GP*

Your Previous Address

This is usually the address when you were last registered with a GP

Your first UK address*

Date you first came to UK

DD slash MM slash YYYY

Are you returning from the Armed Forces?*

Yes

Please indicate if you have ever served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas*

Regular

Reservist

Family Member

Address and Postcode before enlisting*

Service or Personnel Number*

Enlistment date*

If you are registering a child under 5

Child Health Surveillance

I wish the child above to be registered with the named doctor for Child Health Surveillance

If you need a doctor to dispense medicines and appliances

Nearest Chemist

I live more than 1 mile in a straight line from the nearest chemist

Chemist Difficulty

I would have serious difficulty in getting them from a chemist

Signatures

Signatures*

Patient's signature

Signature on behalf of patient

Consent

I agree for the Practice to contact me using the details provided above.

Electronic Signature (Type your full name here)*

By completing the section above, I hereby sign this form electronically

NHS Organ Donor Registration

Would you like to join the NHS Organ Donor Register?*

Yes

Already on it

I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death.*

Any of my organs and tissue

Kidneys

Heart

Liver

Corneas

Lungs

Pancreas

NHS Blood Donor Registration

Would you like to join the NHS Blood Donor Register?*

Yes

Already on it

Tick here if you have given blood in the last 3 years

I have given blood in the last 3 years

My preferred address for donation is:

About You

What is your first language?

Ethnic Group*

White British

White Irish

Black Caribbean

Black African

Asian

Indian

Pakistani

Chinese

Mixed Caribbean

Mixed African

Other

Please list any serious illnesses / operations / accidents / disabilities and for women any pregnancy related problems and the year they took place*

Your nominated Pharmacy*

Have you ever suffered from

Epilepsy

High Blood Pressure

Heart Attack/Stroke

Cancer

Eczema/Hay Fever

Blindness/Glaucoma

Diabetes

Depression

Asthma

COPD

Please list any medications taken and the amount*

Family history - please state any serious illness, in particular cancer, heart disease, stroke, high blood pressure, diabetes or any inherited disease. Please also state your relationship to the individual and in the case of cancer, the type of cancer.*

Next of kin - please give name, address and telephone number of next of kin*

Are you allergic to any medications?*

Yes

Which?*

Do you have a carer?*

Yes

Please give details*

Have you ever had a cervical smear?*

Yes

When?*

DD slash MM slash YYYY

Do you smoke?*

Yes

Have you ever smoked?*

Yes

How many cigarettes or ounces of tobacco do you smoke per week?*

Would you like advice on giving up smoking?*

Yes

We offer a smoking cessation advice service at the surgery, if you would like to discuss this with a nurse please make an appointment at reception.

How often do you have a drink containing alcohol?*

Never

Less than monthly

2-4 times per month

2-4 times per week

4 or more times per week

How many units of alcohol do you drink on a typical day when you are drinking?*

1 or 2

3 or 4

5 or 6

7 or 8

9 or more

How often have you had 6 or more units if female, or 8 or more units if male, on a single occasion in the last year?*

Never

Less than monthly

Monthly

Weekly

Daily

Your health record and sharing of information

Your heath record includes your medical history, details about your medication and any allergies you may have. You can now choose whether to share these full medical details.

We use a secure electronic health records system called SystmOne. With your permission, this system can allow clinicians to share your full record held here with other healthcare services who are providing care for you. These other services will ask your permission to view your record.

Many organisations may use SystmOne including some GP practices, out of hours services, children’s services, community services and some hospitals. Sharing your health record will help us deliver the best level of care for you.

You have two choices which allow you to control how your record is shared. You can change these choices at any time by letting the relevant practice or service know.

Sharing OUT - This controls whether your information recorded at this practice or service can be shared with other healthcare services.

Sharing IN - This determines whether or not this practice or service can view information in your record that has been entered by other services who are providing care for you, or who may provide care for you in the future.

Imagine you’re receiving care from three services: your GP, a district nurse and a smoking clinic.

You want your GP and District Nurse to share information with each other and you want both of them to know your progress at the smoking clinic. However, you don’t want the smoking clinic to see any of your other medical information.

Your sharing choices at each practice or service would be:

The GP can share information IN and OUT.
The district nurse can share IN and OUT.
The smoking clinic can only share information OUT but not IN.

You can change your choices at any time. Let each practice or service know.

SHARING OUT I would like my health record at this practice or service to be shared with other healthcare services providing care for me.*

Yes

SHARING IN I would like this practice or service to be able to view information in my health record that has been recorded by other healthcare services.*

Yes

Name

This field is for validation purposes and should be left unchanged.

Update your details

Order your Prescriptions

Online Appointment Booking

Patient Participation Group

TPP SystmOne Online Login

Find Your NHS Number

Friends & Family Test

Leave a review

Opening Times

Monday
08:00 until 13:00
14:30 until 18:00
Tuesday
08:00 until 13:00
14:30 until 18:00
Wednesday
08:00 until 13:00
14:30 until 18:00
Thursday
08:00 until 13:00
14:30 until 18:00
Friday
08:00 until 13:00
14:30 until 18:00
Saturday
CLOSED
Sunday
CLOSED

Useful Links

Cottenham Surgery

New Patients

We are currently accepting new patients.

Family Doctor Service Registration

Patient details

Please help us trace your previous medical records by providing the following information

If you are registering a child under 5

If you need a doctor to dispense medicines and appliances

Signatures

NHS Organ Donor Registration

NHS Blood Donor Registration

About You

Your health record and sharing of information

Opening Times

Useful Links

NHS A-Z Conditions

Find Local Services

Live Well

Cottenham Surgery

New Patients

We are currently accepting new patients.

Family Doctor Service Registration

Patient details

Please help us trace your previous medical records by providing the following information

If you are registering a child under 5

If you need a doctor to dispense medicines and appliances

Signatures

NHS Organ Donor Registration

NHS Blood Donor Registration

About You

Your health record and sharing of information

Opening Times

Useful Links

NHS A-Z Conditions

Find Local Services

Live Well

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