Thank you for choosing to register with the Keats Group Practice. Please ensure you complete the details below as accurately as possible.
Last Updated: 22/04/2022
Child's Personal Details
A copy of your baby's birth certificate will be requested seperately.
Child's Ethnicity
Parent / Guardian (s) Details
Next of Kin
Contacting You
Signature of Parent / Guardian
Newborn - SCID Screening (Heel Prick Test)
Complete if registering baby 0 - 8 weeks old
SCID screening is offered, at the time of the Newborn Heel Prick when baby is 5 days old. Please complete the information below as this will be needed before the baby has their 1st immusnisation.
Child's Medical History
Family Medical History