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EXTENDED ACCESS INFORMATION LOCATIONS AND LINKS

Haywood Hospital, High Lane, Burslem, Stoke-on-Trent, ST6 7AG

Leek Moorlands Hospital, Ashbourne Road, Staffordshire, ST13 5BQ

Bradwell Hospital, Talke Road, Chesterton, Newcastle-under-Lyme, ST5 7NJ

Longton Cottage Hospital, Upper Belgrave Road, Longton, Stoke-on-Trent, ST3 4QX

Hanley Primary Care Access Hub. 69-71 Stafford Street, Hanley, Stoke-on-Trent, ST1 1LW

https://www.northstaffsccg.nhs.uk/your-services/extended-primary-care-services

https://www.stokeccg.nhs.uk/stoke-your-services/extended-primary-care-services

Pre-Registration with the practice

PreRegistrationIf you wish to pre-register click on the link below to open the form. When you have completed all of the details, please bring the form personally to surgery along with your proof of identification.  You WILL NOT be registered with us until you attend so that we can get a signature off you as confirmation you are who you say you are.

Pre-registration Form

When you register you will also be asked to fill out a medical questionnaire. This is because it can take a considerable time for us to receive your medical records. There is an online version of this file too, which you may fill out and send to surgery.

Online medical questionnaire for new patients

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.

PLEASE DO NOT SUBMIT THE PRE-REGISTRATION FORM ELECTRONICALLY.

Registration Form

 
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