Many thanks for registering with Lonsdale Medical Group. We want to welcome you to our Practice and let you know some key information about our Practice and also gather some more data so we can make sure we tailor your care to your needs.
Please let us know how you would like to be addressed * Full Name Date of Birth *
Date Format: MM slash DD slash YYYY
Consent Phone Consent Ethnic Category - Please state Please sign me up to the online access system where I can access my health record and order repeat prescriptions Country of Birth * Do you have any special needs to access information? *
eg. I am deaf or blind
Language * Do you need an interpreter? * Are you a carer for someone? * Please tick all that apply I am homeless Please contact me to arrange some support Do you have someone caring for you? * If you do what are their details ( full name and telephone number) Information regarding our services and how to access care can be found at www.lonsdalemedicalcentre.nhs.uk
At Lonsdale we promote self care and tailor our services to the needs of our patients offering a personalised care approach.
If you are feeling unwell please try our self help sections or the options for self referral such as sexual health home testing and physiotherapy referrals.
If none of these options are suitable you can complete an online consultation and a member of our team will review your case within 24 hours. You may be directed to a more appropriate service or booked to see someone at Lonsdale.
At Lonsdale we promote the use of the Summary Care Record to *
Details can be found here
All patients registered with a GP have a Summary Care Record, unless they have chosen not to have one. The information held in your Summary Care Record gives health and care professionals, away from your usual GP practice, access to information to provide you with safer care, reduce the risk of prescribing errors and improve your patient experience.
We also promote the use of the electronic prescribing service which allows us to send prescriptions directly to the pharmacy of your choice. Please state the Pharmacy of your choice * If you live in England, Wales or Jersey, are not in a group excluded from opt out legislation and you have not registered an organ donation decision, it will be considered that you agree to be an organ donor. This is known as deemed consent. Please note: recording opt out here will NOT opt the patien tout of the central register; they need to go online to the NHS donation website to record this: *
Please note the Practice will need to opt the patient out via a government website.
Do you have a Disability? * Are you housebound? Please say yes or no * Section Break Lifestyle Advice and Clinical Information
Thank you for taking the time to complete the questionnaire so far. This next section is to gather some clinical information and up to date lifestyle advice to help us tailor the service to your needs.
At Lonsdale we are passionate about improving the health and well being of people and we regularly post health and lifestyle information on our social media. Please follow us on Facebook and Instagram. There is a wealth of information on our website and also on nhs.uk
If you have a long term condition, we offer you an appointment in the month of your birthday to ensure you have all the support and care you need and are involved in decisions. You will be contacted by a member of the month of birth team when your birthday arrives. A lot of our recalls are currently being done remotely via smart phone
Can you let us know your smoking status * Alcohol Status *
Units are a simple way of expressing the quantity of pure alcohol in a drink.
One unit equals 10ml or 8g of pure alcohol, which is around the amount of alcohol the average adult can process in an hour.
This means that within an hour there should be, in theory, little or no alcohol left in the blood of an adult, although this will vary from person to person.
The number of units in a drink is based on the size of the drink, as well as its alcohol strength.
For example, a pint of strong lager contains 3 units of alcohol, whereas the same volume of low-strength lager has just over 2 units.
Knowing your units will help you stay in control of your drinking.
Please state how many units of alcohol you drink a week
Exercise Status * Weight in kg * Height in cms * Do you have any significant family history? Are you on any regular medication? Do you have any allergies to drugs? * If yes please say which drug Smear Information ( if female) tick all that apply * If you are able to, please take your blood pressure at home and let us know what your blood pressure is. If you are unable to then we may ask you to come in.
Please see our website with advice on how to take a good blood pressure reading
and use our blood pressure calculator to check your reading
We have an active Patient Group at Lonsdale that help us ensure patients get an excellent service. Would you be interested in being part of this? Please leave an e mail if you are interested Please be aware that we have strict confidentiality protocols. Only you can call to discuss information related to your care including booking appointments * Please note that we offer a Repeat Prescribing Policy at Lonsdale only for medications agreed to be on repeat by your GP at Lonsdale and only if your medication reviews are up to date. *
Please do not request acute prescriptions or medications you have had in the past, instead use our online consultation form available on our website.
Please note we promote continuity of care at Lonsdale, please help us to assess your condition effectively if you are unwell and use our online consultation form ( Econsult) available on our website. * Please note we offer a number of self referral services including physiotherapy and home sexual health testing. Please visit our website for further information *
We actively promote dignity and respect between staff and patients and therefore operate a strict Zero Tolerance Policy at Lonsdale. *
Please ensure you read the policy on our website and accept the terms of our policy.
We will now add you to our systems and will have you up and running on our systems in the next 5 days. We may ask you to come and complete a blood pressure check if at the Surgery and will contact you if needed. You will now be directed to the clinical system to set up your account. We apologise for any repetition.
This field is for validation purposes and should be left unchanged.