Thameside Medical Practice

Thames House, 180 High Street, Teddington, Middlesex, TW11 8HU

Current time is 00:07 - Sorry, we're closed

Telephone: 020 8614 4930

Out of Hours: 111

Online registration for children aged 6 and under

New Patient Registration Child aged 6 and under

Please ensure you fill this form out in full. If the form does not have enough information, we can not register you at the practice.

Please select below*
- Master
- Miss
Please provide your child's full name*
Please provide any previous forenames or surnames that may help us find your child's NHS England medical records
Date of birth*
DD slash MM slash YYYY
Place of birth (please note 'London' is not accepted.)*
Current address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous registered address that relates to when your child was last registered at a GP practice. This will help us obtain medical records.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Previous GP practice address and name. If you have registered your child with a practice in England, we will need this to find their medical records.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
School (if applicable)
Please provide your child's NHS number

The previous GP or dentist can give this information to you.
If your child was not previously registered with NHS England please tell us the date in which they entered the U.K
MM slash DD slash YYYY
Phone
Email
Next of Kin (NOK) details

Please provide a contact number, the relation to you and name for your next of kin. Should the practice be unable to reach you, or there is an emergency within your appointment, this person will be contacted.
Name of parent(s) OR person with legal parental responsibility registered at this practice

We will link this registration to the above
It is esssential that you provide FULL details of your Child's Immunisation History
If you do not have a FULL record of the childhood immunisation(s) that your child has had OR If your child received their childhood immunisation(s) abroad OR If you do not consent for your child to be immunised, PLEASE make an appointment with the Practice Nurse
Please tell us your child's ethnicity*
Please tell us your child's preferred language ( if not English)
Is your child allergic to any drugs? If 'yes' please specify
Does your child have non-drug allergies? If 'yes' please specify
Is your child taking any regular medication? If 'yes' please list them below and the reason you have been advised to take them.

If you do not have current information of your child's medication please make an appointment with our Pharmacist
Does your child suffer from:
- Asthma
- Heart Problems
- High Blood Pressure
- Glaucoma
- Thyroid Problems
- Diabetes
- Cancer
- Tuberculosis
- Stroke
- Depression or Anxiety
- Other
Please provide details
Is your child registered disabled?
- Yes
- No
Please provide brief details
Height
Weight
Electronic Prescriptions (EPS)

You can now have your prescription sent electronically direct to your chosen pharmacy. Please let us know the pharmacy name and address you wish to collect your medication from
Signature
Name
This field is for validation purposes and should be left unchanged.

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Order your Prescriptions

Online Appointment Booking

Patient Participation Group

Friends & Family Test

Opening Times

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

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