Register with us

The Sloane Street Surgery welcomes new patients at any time. Please fill in the below details for us to have on file when you phone to make a new patient appointment.

New patient appointments can be booked by phoning reception on 0207 245 9333.

Patient Details
Title (*required)
Surname (*required)
Forename(s) (*required)
Address: (*required)
Date of Birth (*required)
Home Telephone
Work Telephone
Mobile Telephone
Email Address (*required)

Correspondence
Please indicate how you would like to receive correspondence from The Sloane Street Surgery (Please note that by selecting these options you are consenting for medical information to be sent by these means) (*required)
Clinical Correspondence
 Email Post
Invoices
 Email Post
Text Reminders (for Appointments only, no clinical details will be included)
 Yes No
Do you have any known allergies? (*required)
 Yes No
If Yes above, please state
If you are registered with an NHS doctor, would you like us to write to them?
 Yes No
If Yes above, please provide their details (including surgery name)
Would you like a chaperone to be present during the consultation and examination?
 Yes No

Accounts & Registration Confirmation
If you are registering a child, or you are not the bill payer, please provide us with the name of the parent or guardian, or person responsible for payment of invoices
Which doctor at Sloane Street Surgery would you like to register with? (*required)
If you would like your invoices submitted directly to your insurance company, please give details below (please note, only International Insurance will cover GP consultations):
Name of Insurance Company
Policy Number
I confirm that the above information is correct to my knowledge and I wish to register as a patient at The Sloane Street Surgery (*required)
Patient or Guardian Signature (please type name in CAPITALS) (*required)
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