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Lonsdale Medical Group

Lonsdale Medical Centre |24 Lonsdale Road, London, NW6 6RR

Current time is 07:36 - If you are unwell and cannot wait until we are next open, please call 111.

Blessing Site |307 Kilburn Lane, London, W9 3EG

Current time is 07:36 - If you are unwell and cannot wait until we are next open, please call 111.

NHS

Telephone: 020 7328 8331

admin.lonsdale@nhs.net

Latest News (click title to open):

New Automated Telephone System

Patient Update Autumn 2020

Frailty Index on Online Records and other calculators

You are here:
Home
/
Patient Self Referral

You are here:
Home
/
Patient Self Referral

Patient Self Referral

Antenatal

Drugs and Alcohol Support

Addaction Brent – support for people with alcohol and drug related issues

Lifestyle

Mental Health

Talking Therapies for support with depression and mental health problems
Support for Mental Health Problems / Improving Access to Psychological Therapies
Telephone: 0208 206 3924

Sexual Health

Contraception, Cervical Cancer Screening, Chlamydia and family planning services

Smoking Advice and Support

Brent Smoking Cessation Service

Social Isolation

The aim of the project is to target and address social isolation in individuals who are over 18 and identified as being at risk of, or suffering from, social isolation, lack of social contact and low community involvement.
Telephone: 07415315998 | 020 30111 698
Email: sibi@cvsbrent.org.uk

Support Groups

Support for Carers, People with Physical Disabilities and Domestic Abuse

Transport to or from Hospital

Help with organising transport to or from hospital

Update your Details

Patient Online Access Webpage

Patient Participation Group Sign Up

Friends and Family Test

Apply to Access your Online Records

New Patient Pre-Registration Form

When we are Closed

Feedback Form

Lonsdale Medical

Monday
08:00 until 18:30
Tuesday
08:00 until 18:30
Wednesday
08:00 until 18:30
Thursday
08:00 until 18:30
Friday
08:00 until 18:30
Saturday
CLOSED
Sunday
CLOSED

Blessing Site

Monday
09:00 until 17:00
Tuesday
09:00 until 17:00
Wednesday
09:00 until 17:00
Thursday
09:00 until 17:00
Friday
09:00 until 17:00
Saturday
CLOSED
Sunday
CLOSED

Useful Links

NHS Choices

NHS 111

Patient UK

Contraception Choices

Expert Guide to Unwell Children and Babies

LGBT Foundation

Domestic Violence Aware Practice

Samaritans

Crisis

Kooth Youth Support

MECC Link

Update your Details

Name*
First Last
Date of Birth*
Current Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Are you a carer for someone?*
- Yes
- No
New Address
Please ensure the address is still in our catchment area
Current Mobile Phone
New Mobile Phone
Consent for Text Messages
I agree to the Practice sending texts for direct patient care
Email*
CAPTCHA
Privacy*
- By using this form you agree with the storage and handling of your data by this website.
Name
This field is for validation purposes and should be left unchanged.

New Patient Pre-Registration Form

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*
- Mr
- Mrs
- Miss
- Master
- Ms
- Mx
- Dr
First Name*
Surname (Family name)*
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
House/Flat number Street City County / State / Region ZIP / Postal Code Country
Contact number
Landline Mobile Work

Please provide us with the most convenient way in which you would like to be contacted. *A minimum of one number is required
Consent
I agree to being contacted by the Practice for direct patient care via text
A lot of our communications are now on line. Being able to contact you via text helps you get the full experience of our services
Email
Consent
I agree to being contacted by the Practice via e mail for direct patient care
Do you know your NHS number?
You can retrieve your NHS number from your previous GP Practice, or can be found on any hospital letters. Providing your NHS number allows us to link to your medical records faster than without it.
GMS1 Form https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/826307/GMS1-family-doctor-services-registration-form.pdf*

Kindly complete the GMS1 form using the link attached. Please note, without this, we will not be able to complete your registration.
GMS1 Form*
Kindly upload your completed GMS1 form here.
Ethnic Category - Please state
Please sign me up to the online access system where I can access my health record and order repeat prescriptions
Yes please
Do you have any special needs to access information?*
eg. I am deaf or blind
Language*
Do you need an interpreter?*
- Yes
- No
Are you a carer for someone?*
- Yes
- No
Please tick all that apply
Do you have someone caring for you?*
- Yes
- No
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*
- Express consent for core summary care record
- Express Dissent consent for core summary care record
- Express consent for core and additional summary care record
Details can be found here https://digital.nhs.uk/services/summary-care-records-scr/summary-care-records-scr-information-for-patients 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:*
- Yes Im willing to be a donor
- No I do not want to be a donor
Please note the Practice will need to opt the patient out via a government website.
Do you have a Disability?*
- Registered blind or partially sighted
- Deaf or hearing difficulty
- Dependence on wheelchair
- Speech Problem
- Other
- None
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*
- Current Smoker
- Non smoker
- Ex smoker
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*
- Competitive Athlete
- Exercise physically impossible
- Enjoys light exercise
- Enjoys moderate exercise
- Enjoys heavy exercise
Weight in kg*
Height in cms*
Do you have any significant family history?
Are you on any regular medication?
- yes
- No
Do you have any allergies to drugs?*
- yes
- No
If yes please say which drug
Smear Information ( if female) tick all that apply*
- Up to date with smear tests
- Due a smear test
- History of oopherectomy
- History of hysterectomy
- not sure or not applicable
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 https://lonsdalemedicalcentre.nhs.uk/how-to-use-a-blood-pressure-monitor/ and use our blood pressure calculator to check your reading https://lonsdalemedicalcentre.nhs.uk/how-to-use-a-blood-pressure-monitor/
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*
- I accept
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.*
- I accept
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.*
- I accept
Please note we offer a number of self referral services including physiotherapy and home sexual health testing. Please visit our website for further information*
- I accept
https://lonsdalemedicalcentre.nhs.uk/appointments/
We actively promote dignity and respect between staff and patients and therefore operate a strict Zero Tolerance Policy at Lonsdale.*
- I accept
Please ensure you read the policy on our website and accept the terms of our policy.
Please ensure you read our privacy policy*
I agree to the privacy policy.
https://lonsdalemedicalcentre.nhs.uk/gdpr/
Please upload photo ID*
Please upload a proof of address*
Thank you so much for completing this form.
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.
Email
This field is for validation purposes and should be left unchanged.

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