To complete your registration with us, YOU MUST now fill in this Health Questionnaire. The Health Questionnaire is compulsory for registering you as a new patient. Please give us as much information as you can.
Please note that we will not respond to any medical information or questions received via this form.
The information you supply us will be used lawfully, in accordance with the Data Protection legislation and GDPR.
Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of communicating with the practice.
Are my details secure?
The internet is not a secure place, however, we have gone to great lengths to make sure the information you submit to us is as secure as possible.
This website runs within a secured connection (256-bit SSL). So any information entered into the system is transmitted in encrypted form (you will see the little lock symbol in your browser address bar to confirm this). Details are transferred to your practice via a TLS-encrypted connection to the NHS email system.
All fields marked with * are mandatory.
Surgery Contact Details
Wellsbourne Healthcare CIC
179 Whitehawk Road Brighton East Sussex BN2 5FLTelephone: 01273 005444