New Patient over 16yrs Questionnaire

By providing your email address and mobile number you consent to the practice contacting you by these methods of communication for direct patient care, including national screening programmes. Please bear this in mind if you share an email account. We will send your log-in details for online-services by email, please check your junk folder if you do not receive them within 7 days.

Last Updated: 30/04/2021

Your Contact Details

Information About You

Medical Information


Females Only




Family History

Next of Kin

For patients aged 65 and over or those with a chronic disease (e.g. asthma or diabetes)

Summary Care Records

A Summary Care record is an electronic record that can help give you safer, faster care by giving healthcare staff instant access to information about your MEDICINES, ALLERGIES and MEDICINES which make you ill.

Enhanced Data Sharing Model

SystmOne is the clinical computer system used by Penryn Surgery. Opting into this method of sharing your medical information will allow other services who use this same clinical computer system, eg District Nurses, to access your medical record but ONLY if they have need to do so for your clinical care.

National Data opt-out

Information about your health and care helps the NHS to improve your individual care, speed up diagnosis, plan your local services and research new treatments. In May 2018 strict rules about how this data can and cannot be used were strengthened. You can choose whether your confidential patient information is used for research and planning. To find out more visit Leaflets on all the above data sharing models can be obtained from reception.