Hastings House Medical Centre - Leaflets & forms

Forms

	Name	Description
	Carer Registration Form	This form enables us to register you as a carer, as explained in the attached document. It also contains some useful contact information and resources.
	New pregnancy registration form.pdf	Use this form to tell us about your pregnancy, and return it to the practice so we can arrange a midwife booking appointment for you - this would usually be when you are 10-12 weeks pregnant.
	Patient agreement for a carer to have access records	Patients should use this form to allow the surgery to discuss details of their medical records with their nominated carer, and/or allow direct access to written records about their health.
	Physiotherapy self-referral form	This form allows patients over the age of 16 to self-refer for physiotherapy assessment and treatment for free on the NHS. Physiotherapists can assess and treat a wide variety of muscular or joint problems such as back or neck pain, strains, sprains, joint or muscle pains.

Hastings House Surgery, Wellesbourne - Rivers Way, Wellesbourne, Warwick, CV35 9RH

Little Thatch Surgery, Kineton - Warwick Road, Kineton, Warwick, CV35 0HN