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Send a Message
Have your Say
Compliments/Feedback
Friends and Family Test
Patient Opinion
Patient Participation Group
Practice Survey Reporting
In Loving Memory
Making the most of your Practice
Our Team
Allied Healthcare Professionals
Doctors
Nurses
Practice Administration Team
Dispensary Team
Practice Policies
At the Practice
Baby Friendly
Chaperones
Chaperone Policy
Clinical Governance
Clinical Research
Consent Protocol
Disability Access
Duty of Candour
Equality and Diversity
Infection Control
Named GP Policy
Non-Smoking Premises
Quality Assurance
Removal of Patients from our List
Social Media
Safeguarding Children
Shared Decision Making
Unacceptable Actions Policy
Zero Tolerance
Data
Care Data
Freedom of Information
General Practice Extraction Service (GPES)
Your NHS Data Matters
Patient Record
Data Sharing Preferences
Multi-Disciplinary Teams
The National Care Record Service (NCRS)
Choose if data from your health records is shared for research and planning
Summary Care Record
Organ Donation
Sharing your Information with Others
How we use your Data
Confidentiality
Privacy Policy
Online Access
Proxy Access
Patient Rights
Complaints
Entitlement to NHS Treatment
Patient Advice and Liaison Service (PALS)
NHS Patient Rights
Your Rights and Responsibilities
Website Policies
Accessibility
Cookie Policy (UK)
Copyright
Disclaimer
Regulations & Governance
Clinical Commissioning Group
NHS Derby and Derbyshire Clinical Commissioning Group
GP Earnings
Care Quality Commission (CQC)
NHS Services
The NHS Constitution for England
NHS Derbyshire Healthcare
Teaching
Appointments, Tests & Referrals
Appointments
Self-Referral Services
Pregnancy Assessment Unit (PAU) in Derby
Talking therapy
Counselling Service
Live Life Better – Derbyshire
Need help with a drug or alcohol problem?
Physiotherapy
Sexual Health
We are with you
Walking for Health
Referral for Further Care
NHS e-Referral Tracking
Referral to Hospital by your GP
See a Doctor or Healthcare Professional
Tests & Investigations
Access Your Test Results
Other Common Tests
Urine Tests
X-Rays & Scans
What is a Blood Test?
Who Do I See?
Clinics & Services
Clinics
Antenatal Care
Child Health Checks
Clinics we provide
Long Term Conditions
NHS Health Check aged 40 – 74
Travel Clinic & Holiday Vaccinations
Online Services
Register for Online Services with the NHS App
NHS App
Practice Services
Advocacy Service
Contraceptive Services
Dispensary
Dementia Services
Cervical Screening
Diabetes Services
Hepatitis B Immunisation
Private Healthcare
Register with us as a New Patient
Further Help about how to Register with a GP
Registration Policy
Temporary Services
Housebound & Older People
Home Visits
Interpreting Service
Message in a Bottle
New Medicine Service (NMS)
Non NHS Services – Chargeable
Order a Repeat Prescription
Antibiotic Use
Wasted Medications
Electronic Prescriptions
Ashbourne Community Transport & Derbyshire Connect (ACT)
Sick or Fit Note
Telephone System
Texting Service
Your Care
COVID-19
Disability
British Deaf Association
Autism
Action on Hearing Loss
Contact – for Families with Disabled Children
Disability Rights UK
Deaf or Hard of Hearing
Get Active with a Disability
How to Care for a Disabled Child
Learning Disability
National Autistic Society
SCOPE – Equality for Disabled People
Vision Impairment
Health and Wellbeing
Children’s Health
Change4Life
Children and Young People’s Services
Childline
ERIC – The Children’s Bowl & Bladder Charity
Looking after your Child’s Health
Triple P – Positive Parenting Programme
Your Guide to Childrens Coughs, Colds, Earache & Sore Throats
General Health Advice
More about Sprains and Strains
Antibiotic Awareness
Food Allergy
Diarrhoea and Vomiting – Do’s and Don’ts
Healthcare Associated Infection
Vitamin B12 or folate deficiency anaemia
Managing an Infection
Menopause
My Live Well with Pain
Know Who to Turn to for Your Healthcare
Accident & Emergency
Dentist
Hospitals
NHS Out of Hours Services
Optician
Pharmacist
Lifestyle Changes
Alcohol & Drug Services
Healthy Eating
Physical Activity – The Single best Medicine
Social Prescribing
Weight Management
Stop Smoking Service
Long Term Conditions
Asthma
Breast Cancer (female)
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Heart Disease
Dementia
Dementia with Lewy bodies
Diabetes
Epilepsy
High Blood Pressure (Hypertension)
Osteoarthritis
Prostate Cancer
Testicular Cancer – Check Yourself
Mental Wellbeing
Depression
Doc Ready
Dealing with a Mental Health Crisis or Emergency
Every Mind Matters
Feeling down or anxious? Beating the Blues 24/7 can help…
Healthtalk
Lifelink
Making Space
Mind – for better Mental Health
Mental Health Helplines
Mental Health – General Advice
Mental Health Issues if you’re Gay, Lesbian or Bisexual
Rethink Mental Illness
Samaritans
SANE
Time to Change
Pregnancy & Baby
Am I Pregnant?
CRY-SIS Helpline
Maternity Services Locations
Postnatal Care
Postnatal Depression
Smoking affects your Unborn Baby
Start 4 Life
Sexual Health & Sexuality
Contraceptive Advice & Sexual Health
Your Contraception Guide
Free Condoms
Gender Dysphoria
LGBT Foundation
Maria Stopes UK
Sexual Health
Sexually Transmitted Disease
Preventative Medicine
Annual Health Check
HPV Vaccination
Flu Vaccination
Pneumococcal vaccine
Shingles
Screening Services
Help & Support in your Area
Age UK Derby & Derbyshire
Changes
Community Podiatry
Community Directory Derbyshire
Derbyshire County Council
Women’s Cancer Support Group
Help and Support Organisations
Age UK
DrugFAM
Bereavement
At a Loss
Family Lives
Got a teenager?
Humankind
Health Unlocked
Motor Neurone Disease Association (MNDA)
MS Society
Orchid – Fighting Male Cancer
Shelter- England
Same You
The Pavement
The Brain Tumour Charity
Palliative Care information
Cancer Support Services
End of Life Care
#hellomynameis
Together for short Lives
Treetops Hospice Care
What end of life care involves
Supporting Others
Services for Carers
Derbyshire Carers Association
Carers UK
Young People
Bitesize
Brook – Sexual Health & wellbeing guide for under 25s
Can I see the GP or Nurse on my own?
Derbyshire ACE youth worker trust
Kooth
Sexual Health
The Mix
Young Minds
Teenage Friendly
ZoomPhysio
Your Record
Accessing your Record
Access for Others
Subject Access Requests(SAR)
Keep us up to Date
Change of Contact Details Form
Register as a Carer Form
Register for Online Services Form
Communication Consent Form
Health Review Forms
Alcohol Consumption Review Form
Asthma Review Form
Blood Pressure Review Form
Breathlessness Review Form
Epilepsy Review Form
Male Urinary Tract (IPSS) Review Form
Mental Health Review (PHQ-9) Form
Smoking Review Form
Travel Risk Assessment Form
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Carer Details
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*
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*
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*
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*
Please use format day/month/year e.g. 12/05/1979
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Heard Island and McDonald Islands
Holy See
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Iraq
Ireland
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Israel
Italy
Jamaica
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Jordan
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Peru
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Poland
Portugal
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Qatar
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Saint Barthelemy
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Samoa
San Marino
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Saudi Arabia
Senegal
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Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
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Spain
Sri Lanka
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Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
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Togo
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Turkey
Turkmenistan
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Tuvalu
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United Kingdom
United States
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Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Details of Person You Care For
First Name
*
Last Name
*
Date of birth
*
Please use format day/month/year
Address of person you care for
Address of person you care for
Address of person you care for
Address of person you care for
Town/City
Town/City
County
County
Postcode
Postcode
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
What relationship to you is the person you care for?
Is the person you care for a patient at this surgery?
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