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The Apples Medical Centre
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New Patient Health Questionnaire

We give all our new patients the opportunity to meet their new doctor or nurse for a New Patient Check-up. This gives your doctor/nurse the opportunity to meet you and chat about any past illnesses or problems, which affect your well-being. The doctor/nurse will offer to measure your height, check your weight and take your blood pressure. The doctor/nurse will also require a specimen of urine to test and any previous repeat prescription slips, please bring these with you.

To attend for this check-up, which takes approximately twenty minutes, the receptionist will arrange a convenient appointment for you.

If you are on repeat medication, we advise that you have at least 2-4wks supply before registering. Once we have your registration form, we will offer you a telephone appointment with one of our Pharmacists who will go through your medication with you and update our records.

You can also arrange to Book On-Line to issue your repeat prescriptions. Please contact Reception for your online details.

You can also arrange to Book On-Line for future appointments and to issue your repeat prescriptions. To obtain your password from reception requires the presentation of one form of photo identification and one proof of address document.

We have a Patient Participation Group at the surgery. If you would like to join this group, then please ask for details at reception.

If you have downloaded the Questionnaire (DOCX, 27KB) from our website, please feel free to complete it on a computer or by hand. We require that the form be signed and dated, which ever method you have chosen. Once you have completed the questionnaire, please bring it to reception along with your completed GMS registration form and proof of identity and address.

Yours faithfully,

Philippa Cannings
Practice Manager

New Patient Health Questionnaire
(Sign language, large print, braille, easy-read etc.)
YOUR MEDICAL HISTORY
DRUGS AND MEDICINE

If you are taking regular medication please bring the repeat prescription slip to your new patient check.

PERSONAL HISTORY
u/wk.
/day
If you supply us with an e-mail address consent is implied for contact by this method.
Practice Participation Group (PPG)

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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The Apples Medical Centre

East Mill Lane, Sherborne, Dorset, DT9 3DG

  • 01935 812633
  • applesmedcentre@nhs.net
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Local Services
Residential/
Nursing Care
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Nursing Care Jobs
Advertise Your
Business Here