Register with the practice

  • Personal Information

  • Other medical information

  • Please list all past illnesses, operations and accidents. State year, place, hospital and specialist.
  • Please include vitamins, minerals and supplements.
  • Family History*

    Your family history. Please include the following information. If living their date of birth and state of health, if deceased their age at death, cause of death and approximate date of death. If you are unable to answer the questions please enter Unknown or Not applicable as each question requires an answer.

  • To allow us to comply with the Care Quality Commission regulations, please provide answers to the following questions:

  • The practice has a complaints procedure. Confidentiality is respected at all times.

    Please note:
    We do not have wheelchair/disability access or facilities. We could therefore recommend a local practice.

  • By submitting this form you agree to Dr Susan Horsewood-Lee saving your personal information for the purposes of dealing with your request or enquiry. You can read our Data protection policy here.