Burnham Health Centre

Practice forms and registration

Though all practice forms can be found on their relevant page, on this page we provide an overview which includes all of our practice forms with links to the page each form is found on. You may be directed to this page by one of our clinicians or administrative staff to help you find a form to complete and help in your care.

There are two types of forms:

  • Downloadable forms: You can bring the completed form to the surgery, or post or email it to us using our details found under Contact Us.
  • Online forms: which you can open, complete and submit to the surgery directly.

Forms have been colour coded to make them easier to find on relevant pages.

If you have any difficulties with downloading forms or submitting online forms, please speak to reception who will help you. We also have spare forms in reception.

Popular patient forms

Links to pages with popular forms

All patient forms

new patients registration

This page includes all the forms required for new patient registration

  • PRF1 form
  • Temporary resident form
  • Online Registration form

Update Your Personal Details

The form on this page includes information on

  • Contact details including changes of name, address, telephone numbers, email address or emergency contact details
  • Consent for communication (with texts and emails)
  • Carer registration (Tell us if you are a carer)
  • Veteran registration (Tell us if you are a veteran)
  • Student registration (Tell us if you are a student)

Update your clinical record

Update Your Clinical Record

This page includes a number of forms covering clinical care.

  • The “universal medication review” form
    We may ask you to complete this form for any medication review, particularly an annual review.
  • The “health data” form
    We may ask you to complete this form if we only want information on your blood pressure, weight, smoking or alcohol.
  • The “long term conditions interval review” form
    We may ask you to complete this form between annual medication reviews particularly if you are on blood pressure medication.

Other health conditions forms include

  • Epworth Sleepiness Scale for obstructive sleep apnoea
  • International Prostate Symptom Score (I-PSS) for a Male urinary tract assessment

Quality Care Checklists
This page also includes all our quality care checklists for various medical conditions (e.g., asthma, depression and anxiety, medication etc.) which are designed to inform patients including local support where relevant. The local support you can access directly without needing to go through the practice. Though these checklists are in a form format, unlike other forms they are not submitted back to the practice. There is further information on checklists on this page.

Travel Clinic

Travel Clinic

This page includes a form

  • Travel questionnaire

Immunisation Clinic

Immunisations Clinic

This page includes a form

  • Child immunisation refusal

Online access to your records

Online Access To Your Records

This page includes forms for

  • Obtaining online access to your medical record, including for prescriptions, blood tests (practice investigations), reviewing your record and booking/ cancelling appointments
  • Allowing another person to access your medical records (proxy access)

Your records and your options – including proxy access

Your Medical Records

This page includes forms for

  • Summary care record opt out
  • Sharing your data for research and planning in the NHS and your choice to opt out
  • Organ donation and your choice to opt out
  • Subject Access Request (to obtain access to your notes beyond online access)

Online Access To Your Records

This page includes forms for

  • Obtaining online access to book/ cancel appointments
  • Allowing another person to access your medical records to book/ cancel appointments (proxy access)

Book Or Change An Appointment

This page includes a form to

  • Cancel an appointment

Online Access To Your Records

This page includes forms for

  • Obtaining online access to your prescriptions and blood tests (practice investigations)
  • Allowing another person to access your prescriptions and test results (proxy access)

Prescriptions And Medication

This page includes no forms at present but any forms for prescriptions will be added here.

This covers a number of pages and forms including

Feedback and complaints

Friends And Family Test form (to provide general feedback to the practice).

Comments And Suggestions form ((to provide specific feedback to the practice).

Complaints form (to make a formal complaint).

Patient participation group

Patient Participation Group form (to be part of a practice reference group and/or to join our patient participation group).

Get A Fit (Sick) Note

This page includes forms

  • To give to your employer if you have had 7 days off sick or less
  • To request a sick note, from the practice if you had over 7 days off sick and have previously been seen by the practice.

Self-referral forms on Bucks Health Hub

There are many self-referrals which can be found on Bucks Health Hub, many of which do not require forms. A list of the more common self-referrals (with and without forms) can be found under contact details and self-referral.

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