If you are registering a new patient under the age of 16, you will need to provide reception with details of their immunisations. The registration will not be processed without this information.
Do you have any of the following conditions? If yes, please provide details includingyear of diagnosis
1 unit is half pint of regular beer, lager or cider, one very small glass of wine, one single measure of spirits, one small glass of sherry, one single measure of apertifs
Please list all the medicines you use including those you buy from the chemist
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 and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to Preston Hill Surgery • 121 Preston Hill, Kenton, Harrow, HA3 9SN.
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.
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