HEALTH QUESTIONNAIRE

St Paul's Surgery Health questionnaire for Newly Registered Patients

Personal Details

Which ethnic group do you belong to:

Which ethnic group do you belong to:

Are you from abroad?

Are you from abroad?

Are you returning from the army?

Are you returning from the army?

Are you a Student?

Are you a Student?

Have you been a patient at St Paul's Surgery before?

Health Questionnaire

Have you been a patient at St Paul's Surgery before?

Smoking habits?

Smoking habits?

Would you like support to quit smoking?

Would you like support to quit smoking?

Are you on current medication (repeat)?

Are you on current medication (repeat)?

Are you a full time carer for a dependant person?

You need to book in for a medication review with your registered GP before we can reissue.

Are you a full time carer for a dependant person?

Do you have a carer?

Do you have a carer?

How did you hear about us?

How did you hear about us?

Are you aware of what a Summary Care Record is and that you will be automatically enrolled unless you opt out?

Are you aware of what a Summary Care Record is and that you will be automatically enrolled unless you opt out?

Are you aware of what the Hampshire Health Record is and that you will be automatically enrolled unless you opt out?

Are you aware of what the Hampshire Health Record is and that you will be automatically enrolled unless you opt out?

Would you like PatientAccess to enable you to book appointments, order prescriptions and view your medication and allergies history online? If yes please register via our home page link.

If no please find information and opt out forms on our website under the registration page.

Would you like PatientAccess to enable you to book appointments, order prescriptions and view your medication and allergies history online? If yes please register via our home page link.

Send Your Request

We would only contact patients by sms or email for medical reasons. Read our Privacy Policy.

By clicking the Submit button below I confirm that I am an ordinary resident at an address within the Winchester area and that I am legally entitled to register with an NHS GP.

Thank you for registering with us online. Your form will be actioned with 48 hours. Before you are able to use our services we must see you in person with id that includes your current address on it. For example photo driving licence or passport accompanied with a utility bill.

Thank you! Your submission has been received!

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Conditions and TreatmentsFind Local Services

Self Help Advice and Tools

Patient Access

Use Patient Access or the NHS App to book an appointment, order repeat prescriptions and view your medical record.

NHS 111

111 is the NHS non-emergency number. It's fast, easy and free. Call 111 and speak to a highly trained adviser, supported by healthcare professionals.

Mid Hampshire Healthcare

Mid Hampshire Healthcare Ltd (a GP Federation) was created to enhance the delivery of healthcare services within our local area.

Patient Survey

How likely are you to recommend this Surgery to friends and family if they needed similar care or treatment? Please spend 2 minutes to take the Friends and Family Test.

Take the Test

NHS (nhs.uk)

The NHS website. Take control of your health and wellbeing. Get medical advice, information about healthcare services and support for a healthy life.

Patient UK

Patient is one of the most trusted medical resources online, supplying evidence based information on a wide range of medical and health topics to patients and health professionals.

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