New patient registration

Please help us trace your previous medical records by providing the following :
If you are from abroad
If you are returning from the armed forces

New Patient Health Questionnaire (For children up to 16 years of age)

(please tick all those that apply)
Please tell us their name, contact details (if not given above) and their relationship to the child

Health History

Medication

If you have a list from your previous GP please give us a copy
If you have a list from your previous GP please give us a copy
It is important that your child’s immunisations are kept up to date. A current photocopy of the immunisation history will help us to maintain their immunisation record; we can take a photocopy of this at reception. If this is not available then please list below.

Please provide the date that the following immunisations were last given to your child:

Ethnicity & Language Questionnaire

It is important that your child’s immunisations are kept up to date. A current photocopy of the immunisation history will help us to maintain their immunisation record; we can take a photocopy of this at reception. If this is not available then please list below.
It is important that your child’s immunisations are kept up to date. A current photocopy of the immunisation history will help us to maintain their immunisation record; we can take a photocopy of this at reception. If this is not available then please list below.

PLEASE CLICK THE RED ARROW AT THE TOP RIGHT OF THIS PAGE TO READ THIS NOTICE FOR LONGER

Patient Access On-line Services:

You may be aware that Quay House Medical Centre will be merging with four other Hereford medical practices on the 1st of July 2018.

Unfortunately, as a result of the merger process All Patient Access On-line Services will be cancelled and therefore unavailable from the 1st of May until the 2nd of July 2018.

This means the following services will be unavailable between 1st May and 2nd July.

Ordering Repeat Prescriptions, Booking Appointments, Sending Electronic Messages, Changing Address Details and Registering as a New Patient.

After the 2nd of July 2018, patients who wish to use the Patient Access On-line Services will be required to RE-REGISTER for this service.

We sincerely apologise for any inconvenience this may cause but, unfortunately, it is beyond our control.

We would like to thank you for your understanding and patience during our merger process.