Baby Registration for PRINTING – Almond Group Practice

Baby’s Details

Forenames

Surname

Date of Birth

Sex

Male

Female

Address

Town

Postcode

EH29, EH52 and some within EH30 and EH28 as per the boundary

Which town are you nearest to? (for assigning you a health visitor))

Kirkliston, Newbridge or Ratho

Winchburgh

Parent / Carer Details

Who looks after the baby?

Mother

Guardian

Mother’s name

Mother’s Date of Birth

Guardian’s name

Guardian’s Date of Birth

Mobile of Mother or Guardian

If you don’t have a mobile number, please state ‘none’. However, we cannot register you without a mobile or landline number

Landline of Mother or Guardian

Is the Baby’s Father registered at this Practice?

Yes

No

Father’s name

Father’s Date of Birth

Mobile of Father

Parent / Carer Declaration

I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable
NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, the minimum necessary information from this form could be disclosed to relevant authorities.

I understand that more comprehensive information about how NHS Scotland handles my data is available from NHS Inform.

Are you the parent or a carer?

Parent

Guardian

What is your name?

Your relationship to the Baby

Your mobile number in case we need to contact you

Signature

HOW THE NHS USES YOUR INFORMATION

We use your information to provide healthcare, maintain your medical record, and meet our legal obligations as an NHS practice.

As part of delivering your care, your information may be shared with NHS Scotland and other NHS services involved in your treatment, including for appointments, referrals, tests and related correspondence.

For full details about how we and NHS Scotland handle your personal information, please see our Privacy Policy and that of NHS Scotland.

Consent

I agree to the privacy policy