Upload Forms

To register as a new patient please upload:

Completed registration form
Proof of Photo Identification (passport, driving license or birth certificate)
Proof of Address (bank statement or utility bill no more than 3 months old)

You can upload copies of your identity with the form below. If you prefer to submit your documents in person please speak to the reception team. They can also be emailed to the surgery.

Please allow 10 days before your registration will be complete and speak to the practice to confirm your registration. Please ensure that you have enough medication from your old surgery, so that you do not run out whilst waiting to register with us.

File upload

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Telephone number for us to contact you *

File Upload *

Maximum file size: 10MB

Please upload your files to the practice here. We accept tiff, jpg, png, gif, txt, Word and pdf files.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.

I consent to the practice collecting and storing my data from this form.

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Charlton Hill Surgery

The White House