Fearnhead Cross & Longford Street Surgeries

Fearnhead Cross Medical Practice, 25 Fearnhead Cross, Warrington, WA2 0HD. Tel: 01925 847000 Fax: 01925 818650

Longford Street Surgery, Longford Street, Warrington, Cheshire, WA2 7QZ. Tel: 01925 255600 Fax: 01925 634954

Current time is 22:17 - Sorry, we're closed

NHS

Registering as a new patient

There are 3 forms you need to complete to register as a new patient with our practice. The 3 forms are available to download or complete on our website. The first 2 forms must be completed and handed into the practice, they are the registration form and the summary care record consent form. Please click below to download these forms, print them off and return them to the practice:

REGISTRATION FORM

SUMMARY CARE RECORD CONSENT FORM

Once you have completed these forms the final part of your registration is a new patient registration check and a new patient questionnaire. A receptionist will make an appointment for your registration check once you hand in your forms, you will need to complete a new patient questionnaire however. You can either get a paper copy of this from the surgery or complete the form below and send it directly to the surgery

New Patient Questionnaire

  • Please type the name of your next of kin
  • What relation does your next of kin have to you?
  • This information is required by NHS England, please choose one of the drop boxes below.
  • The Surgery offers online services, at the moment these are ordering repeat medication and booking appointments. We need a current email address to proceed. Would you like to sign up to this service?
  • A disabled person is defined in the Disability Discrimination Act as someone with a physical or mental impairment that has a substantial and long term impact on their ability to carry out day to day activities. Having read this do you consider yourself to be covered by this definition? If yes, please state your disability below:
  • Please state any illnesses IE: Diabetes, Asthma, Heart Problems, Blood Pressure, Depression, Epilepsy, Chronic Obstructive Pulmonary Disease etc)
  • Please give any details of any current medication you are taking
  • Including drug allergies (IE: Hayfever, Eczema, Penicillin etc)
  • Have any members of your close family suffered from serious illnesses or inherited disease such as heart conditions, diabetes or cancer? If so, please state them below
  • Please choose from the list below what your current smoking status is
  • If known, please provide us with your current height
  • If known, please provide us with your current weight
  • Do you have a carer?
  • Do you care for someone?
  • Are you or have you ever been a member of the Armed Forces?
  • How often do you have a drink containing alcohol?
  • How many drinks containing alcohol do you have on a typical day when you are drinking?
  • How often do you have six or more drinks on one occasion?
  • How often during the last year have you found that you were not able to stop drinking once you have started?
  • How often during the last year have you failed to do what was normally expected from you because of drinking?
  • How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
  • How often during the last year have you had a feeling of guilt or remorse after drinking?
  • How often during the last year have you been unable to remember what happened the night before because you had been drinking?
  • Have you or someone else been injured as a result of your drinking?
  • Has a relative or friend, or a doctor or other health worker, been concerned about your drinking or suggested you cut down?
  • This field is for validation purposes and should be left unchanged.

Update your Details

Friends and Family Test

  • We would like you to think about your recent experiences of our service.

  • This field is for validation purposes and should be left unchanged.

Opening Times

  • Monday
    08:00 until 18:30
    08:30 - 18:00 Longford Street
  • Tuesday
    08:00 until 18:30
    08:30 - 18:00 Longford Street
  • Wednesday
    08:00 until 18:30
    08:30 - 18:00 Longford Street
    Extended Hours from 6.30 – 8.00pm
  • Thursday
    08:00 until 18:30
    08:30 - 18:00 Longford Street
  • Friday
    08:00 until 18:30
    08:30 - 18:00 Longford Street
  • Saturday
    CLOSED
  • Sunday
    CLOSED