Lavender Hill Patient Registration Form - for CHILDREN

This is the Lavender Hill Group Practice Registration Form for anyone younger than 16 years. When registering a new-born baby (less than 8 weeks old), please bring in the discharge summary provided by the hospital. For registrations of children older than 8 weeks old, please bring the red book or any alternative document of immunisations. The online form is free-text and should therefore be compatible with translation, text-resizing, text reading and many other accessibility adjustments that can be made to the site in it's entirety. If you need the information presented here in another format, please get in touch with the practice. Fields marked "REQUIRED" are compulsory. You should only send this form if you are sure that you are eligible to join this practice. The practice website has details about our catchment area. Please note, completing this form will NOT automatically register you with the surgery. We will contact you once we have processed your application. We aim to do so within 3 working days. This should not delay treatment or care - if you need urgent treatment in the interim, please do discuss this with a member of our reception team. You will be required to present in person to sign your registration form and provide proof of your address. This process is currently delayed due to COVID and we will contact you when have restarted this. Please note, sending this form does not guarantee that you will be accepted onto the practice register. If you are not accepted onto the register we will inform you why, the most common reason is that you do not live within the Practice catchment area.

Last Updated: 12/10/2020

Personal Details

About who looks after your child

About Your Child

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

If you are from abroad


Medical Information

Health Information

Family History

Please let us know if any of your child's close relatives have had any of the following conditions. Please include their relationship to you and the age at which they first developed that condition.


We will automatically get details of your child's previous medications from your previous GP. However, we will not automatically issue these and would like to talk to you about your child's regular medications and your health conditions first. Please do therefore book an appointment with one of our GPs or pharmacists well in advance of when your medication is needed so these can be issued. Thank you.


Online Access

We are able to offer online access for children. This is revoked automatically at the age of 12, and we ask for a new application to be made with your child’s consent. If you have any questions about this, then please speak with a member of our reception and administration team or send the practice an email. Please read the information at on our Online Services Page - This will help you make a decision regarding whether you would online access to booking appointments for your child, requesting repeat prescriptions or accessing their medical record. If you wish to have for your child to have online access via Patient Access in order to book appointments, request repeat prescriptions or to access their medical record, please complete the following:

Data Protection and Sharing

Some Data is collected by the NHS centrally for research purposes. To opt out of ‘National Data’, please visit In accordance with the Data Protection Act, Lavender Hill Group Practice needs consent from any patient for us to leave a message, send a text or information regarding their medical treatment. By providing information on this form you are consenting to be contacted about your child's medical needs by the practice. To make an informed decision about data sharing, please make sure you read our "Your Health Record" Page,

Summary Care Record

Please read the information on our "Your Health Record" Page ( regarding Summary Care Records before informing us of your choice below.



We thank you for completing this form. We will be in touch in due course to request proof of identification. If you require any more information on the practice, please visit our website, If your details change, or you would like to change your choices regarding how we contact you or share your data, please inform us.

SUPPLEMENTARY QUESTIONS and PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

Anybody in England can register with a GP practice and receive free medical care from that practice. However, if you are not 'ordinarily resident' in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of 'indefinite leave to remain' in the UK. Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges. More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment. The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.


Complete this section if your child lives in another EEA country. Do not complete this section if your child has an EHIC issued by the UK. If you are visiting from another EEA country and do not hold a current EHIC for your child (or Provisional Replacement Certificate (PRC)/S1), you may be billed for the cost of any treatment received outside the GP practice, including at hospital.

How will your child's EHIC/PRC/S1 data be used?

By using your child's EHIC or PRC for NHS treatment costs your child's EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your child's clinical data will not be shared in the cost recovery process. Your child's EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

Reception Only