Newbury Street Practice Questionnaire

It may take some time before we receive your medical records from you previous practice. In order for us to provide better medical care, please complete as many questions as possible and provide as much information as you can.

Once you are registered, if you have provided a mobile number you will receive a text message confirming registration and the name of your GP.


Last Updated: 16/06/2022

Personal Details

Armed Forces

Personal Medical History

Alcohol Consumption

A score of 5+ may indicate harmful or hazardous drinking. Pint of regular beer/lager/cider = 2 units, Alcopop or can of lager = 1.5 units, Glass of wine (175ml) = 2 units, Single measure spirit = 1 unit, Bottle of wine = 9 units.

Family History

Thinking of your close family, is there any history of disease such as Asthma, Cancer, Mental Health, Skin Disease, Diabetes, Glaucoma, Heart Disease, High Blood Pressure or Stroke?


General Health and Welfare Information

Donor Register

If you would like to register to be a blood donor or opt out of the organ donor register, please go to our Services page.

Online Services

To register for access to your medical notes please complete the online access form.

Summary Care Record and Oxfordshire Care Summary - YOUR CHOICE

Please note that these records are NOT CONNECTED with the Health and Social Care Information Centre (HSCIC) single database project and will ONLY be used for the purpose of enabling informed care to be supplied directly to you as an individual.

Your patient record is held securely and confidentially on the electronic system at your GP practice.  If you require treatment in another NHS Healthcare setting such as an Emergency Department or Minor Injury Unit, those treating you would be better able to give you appropriate care if some of the information from the GP practice were available to them. 

This information can now be shared electronically via:

1. The Summary Care Record: used nationally accross England

2. The Oxfordshire Care Summary: used locally accross Oxfordshire

In both cases, the information will be used only by authorised health care professionals directly involved in your care.  Your permission will be asked before the information is accessed, unless the clinician is unable to ask you and there is a clinical reason for access. 

A parent or guardian can request to opt out children under 16 but ultimately it is the GP's decision whether to create the records or not, because of their duty of care to the child.  If you are the parent or guardian of a child under 16 and feel that they are able to understand, then you should make this information available to them.