Windmill Health Questionnaire V2

Last Updated: 19/08/2022

Your Contact Details











Information About You










Next of Kin






Previous GP


Allergies




Carers





Women



Smoking





Alcohol




Contacting You


Nominated Pharmacy


Online Access

For options 1 and 2 below, please contact the reception team to setup your account If you require access to view your GP records (point 3 below) we will require a valid photo ID and proof of address.

Personal Data Sharing

If you visit anywhere else for care within the NHS, such as a hospital, we would like to share your details with them (sharing (OUT). This also allows there to share any information with us which will allow up to see any treatments you have elsewhere (sharing IN). Please be aware anyone under the age of 18 is automatically shared due to safeguarding.


Signature



Please ensure you have complete the separate GMS1 form

If you do not complete all the required forms we will not be able to register you as a patient. If you wish to sign up for online services, please complete the relevant form.