Registration with the practice
If you wish to register click on the link below to open the form. When you have completed all of the details, bring it inot the surgery with two forms of ID as specified. When you visit the surgery for the first time you will be asked to sign the form to confirm that the details are correct.
We ask you to fill out a medical questionnaire, this gives us background information that allows up to care for you whilst we await the arrival of your medical records. There is an online version of this file too, which you may fill out and send to us. When you come to the surgery you will be asked to sign this form to confirm that the details are correct.
Online medical questionnaire for new adults
Online medical questionnaire for new children
If you are a carer or receive care please complete the carers form:-
Online carers form
Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.
In addition to Somercotes, we accept patients from Alfreton, Riddings, Leabrooks Swanwick, Ironville, Pye Bridge, Jubilee and South Normanton with the M1 marking the outer edge of our practice catchment area. We are not able to accept registrations from outside of these areas as it may impact on our ability to care for the patients living within our catchment area.