RegistrationS The personal information we keep about you is to help us provide health or social care or treatment, under the Data Protection Act (DPA) 2018. TitleMsMissMrsMrDrRevMxFirst Name *Middle NameLast Name *Date of Birth *in the format DD/MM/YYGender *MaleFemaleTown and Country of birth *Home address *Address in the UKPost Code *You can register with us even if you live outside our practice area! To be eligible for home visits, you must live within the practice catchment area Are you a student *YesNoNHS NumberMobile Phone *Home Phone Work PhoneEmail *Previous Address *If this is not applicable please enter N/AName of previous GP Surgery (If Applicable)Main Spoken Language *Do you require an Interpreter? *YesNoDate of entry into the UKOnly if you are coming from abroadHIV Screening *HIV Screening AcceptedHIV Screening DeclinedAll new patients are eligible for free a HIV test which can be done in surgery by our Practice Nurse/HCA via a blood testCurrent Smoking Status *Current SmokerEx-SmokerNever Smoked TobaccoNominated PharmacyOsbon Pharmacy - 143 Lambeth Walk - SE11 6EETesco Pharmacy - Kennington Lane - SE11 5QUHills Pharmacy - 99 Kennington Lane - SE11 4HQMedimex Chemist - 222 Kennington Park Road - SE11 4DALloyd's Pharmacy in Sainsburys - 62 Wandsworth Road - SW8 2LFVitelow Pharmacy - 26 Clapham Road - SW9 0JGOther [please include name and postcode]The Vauxhall Surgery can send your medication electronically to a nominated pharmacy of your choice to be ready for collection Nominated PharmacyNext of Kin/Emergency Contact *FirstLastNext of Kin Contact Number *Relationship to Patient *How did you hear about us?Patient Signature *Please write your name or parent/carer for under 16s Confirmation *I agree to switch my registered GP practice.By confirming, you are consenting to leave your current NHS GP practice. You are free to change your NHS GP practice at any time.NameSubmit Online Patient Access All patients are eligible to register for Online Patient Access which allows patients to book appointments, order repeat medication and access their medical record.