Forms & questionnaires

We have several downloadable forms and online questionnaires available on the following pages:

Forms available to download are

  1. Antenatal Self referral form – Patients can self refer to the ante natal clinic at Newham University hospital if they are pregnant.  Patients don’t need to be seen or referred  by the GP anymore. Please download the form and take the form to Newham University hospital. Patients can also use the Barking Birth center  form.
  2. Physiotherapy Self Referral Form: Please use the Physiotherapy self referral form if you like to be referred for this service – You dont need to see the  GP for Physio referral anymore.
  3. Termination of pregnancy : Patients wishing to have a termination of Pregnancy can now refer themselves. Please fill the form and take it with you or ring the number on the form to book an appointment.
  4. Online Access Registration Form: We advice all our patients to register for online access and book appointments, request repeat prescriptions, view your medical records etc.  Please fill the form and come to the surgery with a recent proof of address and a photo id to get your login details.
  5. Request for NHS Computer Summary, Private letter etc: To request your NHS Computer summary, or if you require the GP to write a Private letter, please print the form and hand it at reception with the correct fees.  Please note the fees paid is non refundable and the documents will be destroyed if not collected within a month.
  6. GMS1 Registration Form: If you live in our catchment area and would like to register at our surgery, Please fill the GMS1 form and attend teh surgery with a recent proof of address (utility bill or bank statement dated within the last three months). You will be given an appointment with the Health Care Assistant for a new patient health check. Your registration will only be completed once you attned the health check.

Downloadable forms page

We would like our patients to complete the following questionnaires at least once every year to update our records.

  1. Alcohol questionnaire for adults
  2. Asthma annual review questionnaire
  3. Depression review questionnaire

Online questionnaires page