SELF CARE PORTAL Become a patient Home / Become a patient Coronavirus: COVID-19 Changes Please note that you are still able to register with us throughout lockdown. If you wish to register with us, please download the appropriate form below. Once you have filled out the form, please email it back to us at nelccg.roxtonpractice@nhs.net and DO NOT ATTEND THE SURGERY. By downloading the forms below, you can fill them in online or you can print it out and fill it in. If you are unable to do this, please contact the surgery on 01469 572058. Full Registration If you wish to register with the practice you will need to come into the surgery to collect the paperwork you are required to complete. Alternatively, you can print off both sets of paperwork by clicking on the links below. You will need to complete the Pre-registration Form, sign it and bring it to the surgery. If you submit the Pre-registration Form electronically rather than printing it, we still require you to come into the surgery to sign the form, and also bring in your completed New Patient Questionnaire. Patients wishing to register with our practice can do so by downloading and printing out the necessary forms below: New Format GMS New_Patient_Health_Questionnaire_(0-5) New_Patient_Health_Questionnaire_(6-15) New_Patient_Health_Questionnaire_(adult).doc V2 (1) In addition, we also need you to provide proof of identification (preferably photo ID) such as a passport or drivers license. You will also need to provide proof of your address, such as a recent utility bill Temporary Registration If you are ill while away from home or if you are not registered with a doctor but need to see one you can receive emergency treatment from the local GP practice for 14 days. After 14 days you will need to register as a temporary or permanent patient. You can be registered as a temporary patient for up to three months. This will allow you to be on the local practice list and still remain a patient of your permanent GP. After three months you will have to re-register as a temporary patient or permanently register with that practice. To register as a temporary patient simply contact the local practice you wish to use. Practices do not have to accept you as a temporary patient although they do have an obligation to offer emergency treatment. You cannot register as a temporary patient at a practice in the town or area where you are already registered. Download the Temporary Resident Registration Form Third-party consent form Disclaimer: Please ensure that you provide photographic identification from the patient and the third-party. Download the form here: Third-party Consent Form Pilgrim Primary Care Centre Pelham Road, Immingham, DN40 1JW 01469 572058 The Health Centre Pelham Crescent, Keelby, DN41 8EW Weelsby View Health Centre Ladysmith Road, Grimsby, DN32 9SW © 2021 The Roxton Practice - Terms of Service Agreement - Privacy Notice - Report a bug Web Development by Laser Red in Lincolnshire Cookie Policy: By using our website you agree that we can place cookies on your device Tell me more × Translate