To register with the practice
If you wish to register with the Fountain Medical Centre please click on the link below to open the form. When you have completed all of the details, click on the "Send" button to mail your form to us. We also require two forms of identification (1) to include a photo (e.g. passport) and (2) to include your address (e.g. utility bill) which you can upload and send via email to the practice on firstname.lastname@example.org. Please note it takes 48 hours to process your registration.
When you register you will also be asked to fill out the Medical Questionnaire and Additional Registration Information, this is due to the time it takes for the surgery to receive your medical records. To avoid any delay with your registration please complete the 3 forms below and return these to the practice.
Online medical questionnaire for new patients
Note that by sending the form you will be transmitting information about your self across the Internet and although every effort is made to keep this information secure, no guarantee can be offered in this respect.
Alternatively you may print off a registration form and return this to the practice by post.
Additional Registration Information