New Patient Under 16yrs Questionnaire

Last Updated: 30/04/2021

Child's Details

Parental Responsibility

Details of all current residents at child's home address

School and Education

Past Medical History


Summary Care Record is an electronic record that gives the patient faster, safer care. For example, if your child was admitted to hospital, staff there would automatically be able to access information regarding your child's allergies and medicines, so they provide the correct care and treatment. Enhanced Sharing Model - this is to consent to other organisations that are providing care to your child and are also using the same computer system as us to view your child's medical information but ONLY when they have a clinical reason to do so.


We are usually automatically notified with your child's immunisation record, if they have previously been registered with the NHS. If you have previously lived overseas, or lived in Scotland, Ireland or Jersey, we will not be notified and you will need to provide copies of any immunisations your child has received, so we can update their medical record and inform child health. For all children under 6 years of age, please email the immunisation pages from their red book to