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Personal Details
Please double check you've entered the correct email address
May be used to identify you
Change of Name
If your name changed due to Marriage or by Deed Poll please provide the practice with a copy of the appropriate documentation
Change of Address
Change of Phone Number
Change of Gender

Castlegate and Derwent are an inclusive GP Practice.

To ensure we provide you with the best and most appropriate care please answer the below questions.

Please note: if indeterminate is selected, you will be registered into the GP system under your birth gender due to national recall systems.

Please let us know if there is another name you would like to be addressed by

National Recall Systems

To ensure you receive the correct screening invitations please answer the questions below.

Ethnicity
Religion
Registered with an Armed Forces GP

These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you and provide you with the best possible care. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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