Newborn Registration Form & Questionnaire

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

Please note that Proxy Online Access, to some aspects of the child's medical record can be requested for children under the age of 12. Further information and application can be found on our website.

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