as a patient

Register for Willowbrook here

Do you live in the practice area?

Before you can register with the practice, we need to confirm that you live in our catchment area. Please enter your postcode below.

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I have checked my postcode and want to register

Register as a patient

Register as a patient

Thank you for applying to join Willowbrook Medical Centre. We would like to gather some information about you and ask that you fill in the following questionnaire. Please fully complete the form below to help us to give you the best possible care. After completing the form, you will need to bring the following items into the practice:

  • The GMS1 form supplied upon verification
  • Two forms of photographic identification (such as a passport or driving license)
  • Proof of your home address (such as a recent bank statement or document relating to your new home)

Personal details


Additional details about you

Please give your first UK address where you registered with a GP
Address before enlisting

Next of Kin/ Emergency Contact

Online services & data sharing

Your SCR is an electronic summary of key medical information taken from your GP medical record. If you need healthcare away from your usual doctor’s surgery, your enhanced SCR will provide those looking after you with key information to help them give you better and quicker care. Please refer to ‘What is a Summary Care Record’ document for more information or visit:
Risk stratification is the process of identifying the relative risk of patients in a population by analysing their medical history. It's a key enabler for improving the quality of care delivered by the NHS. Willowbrook Medical Centre is taking part in the Risk Stratification programme and will be uploading patient identifiable data for analysis. Patient identifiable information will only be viewable at GP practice level. Any NHS organisation external to the practice using risk stratification will only see anonymised data. For more information please visit
Willowbrook Medical Centre use a clinical computer system called SystmOne to record your medical information. With your consent, you can allow your full GP record to be shared with other healthcare services that are providing care for you and who also use SystmOne. These other services will always ask consent to view your record. For more information please visit our website at

Do you consent to receive the following types of communication (if offered) from Willowbrook Medical Centre?

Carers Information

A carer is a friend or family member who gives their time to support a person in their home, to an extent that the person could not remain at home if this care was not being provided. A carer can receive Carers Allowance, but not a wage and the care they are giving will significantly affect their own life.
If yes, please give their name and contact number

Medical details

In order to continue to receive your repeat medications you’ll need to provide a list of the repeat medication you are on. (Please note, certain medications will require an appointment with the GP before they can be prescribed) Please allow plenty of time to organise repeats. Please provide us with your repeat medication list found on the right hand side or a printed prescription.
i.e. nuts, gluten, pollen, animal hair or certain foods. Please mark “none” if you have no other allergies that you know of
If yes, please tell us how we can support your need
For further information please visit

Alcohol consumption & smoking

1= Never
2= Monthly or less
3= 2 - 4 times Per month
4= 2 - 4 times per month
5= 4+ times per week
1= 1 or 2
2= 3 or 4
3= 5 or 6
4= 7 to 9
5= 10+
1= Never
2= Less than monthly
3= Monthly
4= Weekly
5= Daily or almost daily

We hold smoking cessation clinics  at the practice

You can also get help quitting at:


NHS organ donor registration

“I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death”.
For more information, please visit the website or call 0300 123 23 23

Third party consent

*In accordance with the Data Protection Act, the practice needs consent if you are happy for a 3rd party to collect prescriptions, test results and other medical information on your behalf. Please complete this section if you would like to register a 3rd party.
Please note that we are unable to hand out prescriptions to anyone under the age of 15
EPS enables prescribers - such as GPs and practice nurses - to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient's choice. This makes the prescribing and dispensing process more efficient and convenient for patients and staff.If you have already nominated a pharmacy, please tell us which pharmacy you have chosen. For further information about this service, please talk to your pharmacist of choice.
With this assessment, we can help you to get the best out of your services.

How well can you...

Cannot and do not want to learn
Cannot but would like to learn
Can but choose not to
Can but only with help from others
Currently do it independently


Photographic ID means a passport, driving license, or similar. If you do not have photographic ID then please bring your birth certificate and proof of your home address (such as a recent bank statement or document relating to your new home with your name on).

Once you are registered

If there are any problems with your registration we’ll contact you to clarify any issues, but once your details have been entered into our computerized records you will be able to access:

On-line Services
You will be able to register with our on-line service and access appointments, prescriptions and some sections of your own medical record via the internet. All of the details that you need for this are available by requesting to be registered at reception.

New Patient Health-check
You will be eligible for a new patient health-check with a Practice Nurse/Health Care Assistant. Contact reception if you should like to take this up.

Essential privacy and sharing information

Patient Guide: Sharing your medical record

3. Patient Guide Sharing Your Medical Record v0.2

Patient guide to SystmOnline's Sharing Preferences

4. Patient Guide SystmOnline Sharing Preferences v0.2

Willowbrook Privacy Notice

willowbrook privacy notice