Applications to join the list are made by delivering a signed application form, which can be obtained from the practice, or by completing the form below.

Patients have the right to express a preference from whom they receive services. This preference will be recorded and the practice will endeavour to comply with any reasonable preference expressed but need not do so if the person requested has reasonable grounds for refusing to provide the services or does not routinely provide the service requested. All new patients will be invited to participate in a consultation.  


Stratford upon Avon, surrounding villages. For specific information about your eligibility to join the practice list, please contact our reception team or CLICK HERE to check your postcode.

Personal Details
Current Address Details
Previous GP Details

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

If you are from abroad
If you are returning from the armed forces
Medical History
1 unit = 1 small glass of wine

If you have checked any of the family history boxes above, please outline what relation has/had what condition below:

NHS Organ Donor Registration
NHS Blood Donor Registration
National Database

Our surgery uploads key health information to the National Database to be used with your consent at appropriate times. If you would like us to hide your information from the National Database - Opt-out - please tick below We have more information available at reception – please ask a member of staff

You can change your mind at any time. Please complete a form at Reception

Final Details

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.