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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. 

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 Forum at the surgery. This is an on-line volunteer “virtual” group to help provide and improve the services offered by the Apples. If you would like to join this group then please ask for details at reception.

You can either download the questionnaire here - Patient Health Questionnaire to complete it on a computer or by hand, or alternatively you can complete the online version below. We require that the form be signed and dated, whichever 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

1New Patient Health Questionnaire

(Sign language, large print, braille, easy-read etc.)

2YOUR MEDICAL HISTORY

3DRUGS AND MEDICINE

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

4PERSONAL HISTORY

u/wk.
/day
If you supply us with an e-mail address consent is implied for contact by this method.

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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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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East Mill Lane, Sherborne, Dorset, DT9 3DG
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Your Neighbourhood Professionals. Just a Click Away! Need care but want to stay in your own home? Looking for residential or nursing care? Ensure you or your loved ones receive the very best of care. Choose a home with a good/outstanding CQC rating. Set up a lasting power of attorney before you lose capacity and it
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