Registration Form

Registration Form

Patient's Details

Contact Details

Current Address:
You cannot register if you do not live or work in the catchment area

View our Catchment Area

By providing your email address or mobile phone number you consent that Parliament Hill Medical Centre may inform me of test results, convey personal medical information or send copies of referral letters via email or SMS message.

Parent/Guardian Details

Please help us trace your previous medical records

If you are from abroad

If you are registering a child under 5



Scoring: A total of 5+ indicates increasing or higher risk drinking.

Cervical Screening

Height & Weight

NHS Organ Donor Registration

Do you want to register your details on the NHS Organ Donor Registry as someone whose organs/tissue may be used for transplanation after your death. Please toggle these options on if you would like to join.

NHS Blood Donor Registration