All information supplied will be recorded in your confidential medical records. 

Contact Details

Smoking

Alcohol

Height & Weight - Please tell us your most recent measurements for the following (if known).

Next of Kin

Family History

Medication

Allergies

Past Medical History

Carer Information

History

Special Circumstances

Military Veteran

Communication

We now need you to provide proof of your identification and your address. We ask for 2 things:

Step 1

Step 2

ACCEPTABLE BEHAVIOUR CONTRACT

Dr Waheed & Partners at Pontllanfraith Health Centre, we are committed to promoting access to our services and offering choice wherever possible in the services we provide, and the way we deliver them. An acceptable behaviour contract is an individual written agreement between a patient and their GP Practice.

The contract is between you and Dr Waheed & Partners, Pontllanfraith Health Centre and is valid from the date of application to register as a patient at the surgery.