Register

Dr Rial & Partners

RED&GREEN PRACTICE

Waterside & Blackfield Health Centres

How to Register

You are now able to register 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 choose to fill in the form below, choose to print it, and then send by post or hand it into the it to the surgery.

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).

Any 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.

Thank you for registering with us.

Date of Birth

First Name

Surname

Have you moved here from outside the EU?

Family Member 1

First Name

Surname

Have you moved here from outside the EU?

Date of Birth

Family Member 3

First Name

Surname

Have you moved here from outside the EU?

Date of Birth

Family Member 4

First Name

Surname

Have you moved here from outside the EU?

Date of Birth

Family Member 5

First Name

Surname

Have you moved here from outside the EU?

Date of Birth

Family Member 6

First Name

Surname

Have you moved here from outside the EU?

Date of Birth

Family Member 2

Do you wish to register at Blackfield or Waterside (Hythe) Health Centre?

Previous Address

Current Address

Please give details of your previous GP

Telephone Number

After submitting this form we recommend that you print the details entered for future reference.

You will need to print this form if you intend to send it to us by post, or deliver by hand.

Please check this box to confirm you wish to submit your registration online

Please press submit to send this form to us online. Please note that, after online submission, a new window will open confirming success. If you do not see this window you should call the health centre (02380 845955) to enquire regarding the status of your registration. Thank you for registering with us.