Private Medical Form

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All questions marked with a * are mandatory

Personal Details

Please provide your details to help us find your record.

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Gender: *

Help Us To Help You

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources.

May be used to identify you

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Private Medical

Please note that this is not mandatory for the GP practice to do and may be refused due to current GP work capacity.

There will be a charge which the practice will contact you to discuss.

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This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Addington Medical Practice
Parkway Health Centre (Main Site)
New Addington
Croydon
Surrey
CR0 0JA

Telephone: 01689 849 993

Addington Medical Practice
7 Gravel Hill (Branch Site)
Addington
Croydon
Surrey
CR0 5BG

Telephone: 020 8655 4013

Providing NHS Services

Care Quality Commission
Rating: Good