Register

Dr Rial & Partners

RED&GREEN PRACTICE

Waterside & Blackfield Health Centres

How to Register as a New Patient

You are now able to initiate registration as a new patient with our practice by using this online registration form.

Although it is extremely unlikely, it is theoretically possible for forms of this nature to be intercepted.

If you do not wish to register online you can still request registration documents by popping into either our Waterside or Blackfield surgeries, or calling us.
Click here for maps and contact numbers

By pressing the submit button below you are confirming that you wish to register with us. We will be happy for you to book an appointment as soon as you have submitted the forms, if you wish (click here for details on how to book an appointment).

The extra details that are required from you will be requested by post within 10 days. You will need to provide a form of identification when you first attend the surgery.

Please note that if you are already an existing patient you do not need to complete this form.

Thank you for registering with us.

Please select age group

Address

Which Surgery would you like to register at?

Patient 1

Name

Is this the first time you have registered with a GP?

Patient 2

Please select age group

Name

Is this the first time you have registered with a GP?

Patient 3

Name

Is this the first time you have registered with a GP?

Please select age group

Telephone number

E mail address

Please check this box to acknowledge that you wish to register with the Redandgreen Practice and that this document will be submitted via the internet

Is this the first time you have registered with a GP?

Patient 4

Please select age group

Name

Patient 5

Please select age group

Name

Is this the first time you have registered with a GP?