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Orchard Surgery NHS GP Surgery in Dereham

Temporary patient registration

Temporary Patients Form

Required fields are labelled

Patient’s Details

Title: Required

Mr

Mrs

Miss

Ms

Other

Please specify:

Date of Birth: Required

Please use format DD/MM/YYYY

NHS Number:

First Name: Required

Surname: Required

Previous Surnames:

Email Address: Required

Any responses we send will go to this email address.

Home Address: Required

Postcode: Required

Telephone Number:

Do you have a temporary address? Required

Yes

No

Temporary Address: Required

Temporary Postcode:

Telephone Number:

Doctor’s Details

All details of treatment will be sent to this doctor and address.

Doctor’s First Name:

Doctor’s Last Name:

Address of Doctor:

Postcode:

Telephone Number:

If you are from the Armed Forces

Were you ever registered with an Armed Forces GP?

Yes

No

Enlistment Date:

Please use this date format: DD/MM/YYYY

Discharge Date (if applicable):

Please use this date format: DD/MM/YYYY

If you are human, leave this field blank.

This service is closed for today. Please call the surgery if you require an urgent appointment today.

Sorry, this online service is now closed for the day.

Please use our website for valuable information about how you may help yourself and for what conditions will be more appropriate for a local pharmacy.

You can also access the NHS 111 website for further guidance.

Should you feel you have a matter which is Clinically Urgent and you feel MUST be dealt with today, please telephone reception on 01362 692916.

Otherwise, please submit your request on the next working day.

Thank you.

Commercial Road
East Dereham
Norfolk
NR19 1AE

Get directions

01362 692916

About the surgery

Register with the surgery

Sick (fit) notes

Feedback and complaints

Orchard Surgery

CQC overall rating

Good

25 May 2023

See the report

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