Under 16s New Patient Registration

Welcome to Lilyville @Parsons Green

Completing this form is the first step to registering with the practice.

Please provide your child’s immunisation records and some proof of identification.

You can email it to us or bring it to the reception. The registration will not be completed without necessary documents.

For all children (other than newborns), we need to see copies of the child’s immunisation history (Red Book, or equivalent). If your child has had immunisations done privately or overseas, we still need to see the documentation so we can add this to their record.

Please also note that you can only register your child with us, if one or more of the parents / guardians are also registered with us (or registering at the same time as the child).

  • Patient Details
  • Health Information
  • Further Information
0% Complete
1 of 3

Patient's Details

About You (Parent/Guardian)

Mobile number for text message reminders.

Carers Information

eg. someone who is ill, frail, disabled, has mental health/emotional support issues or substance misuse
eg. family member, friend or neighbour
Preferably a mobile number
eg. Wheelchair, hearing aid, braille, lip reading, sign language etc.

Ethnic Origin

Medical Records

Please help us trace your previous medical records by providing as much of the following information as possible.

If you are from abroad

Please include dates/years.