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Leacroft Medical Practice

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Tel
01293 574747

Fax
01293 562955

Langley House
Langley Drive
Crawley
RH11 7TF
Map

CQC Inspected and Rated
Good

We are currently CLOSED.

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Digital Practice Help

Digital Practice is a service that has been designed to make it easy for patients of this Practice to:

Get answers to their questions
Quickly access the right help and advice for their needs.

By using Digital Practice you will be able to:

Make online requests to your GP Practice such as:

Appointment requests
Appointment Cancellation
Ask the Doctor a question
Ask the Practice a question
Repeat Prescription requests
Help with medications
Request test results
Request sick notes

Submit self-monitoring health reviews
(if requested by the doctor or nurse):

Asthma
Diabetes
Epilepsy
Smoking
Mental Health
Alcohol
Blood Pressure

Find the forms that you need:

New Patient registration
Change of details
Register for online services

Give feedback to the Practice:

Feedback and Complaints
Friends and Family Test

Get advice on common conditions:

Services offered by your GP Practice such as travel services.
Health services and health support groups in your area.
Help from NHS.uk regarding your condition.

Frequently Asked Questions

How do I make a request to my Practice?

To make a request to your Practice select the service that you require.
You will be prompted for information about your request. When you complete a request this will be sent to your practice. The system acknowledges that your request has been sent and will let you know what happens next.
The Practice handles the requests during their normal working day, i.e. if you send a request on Friday pm the Practice won’t normally see it until Monday morning.

How do I receive the responses from the Practice?

On some services, such as Ask the Practice a question and Ask the Doctor a question once the Practice has processed your request they will send you a response. This response will be sent to the email address that you have given in the form.

For security purposes the email will ask that you verify your identification. Once you have completed this the message from the surgery will be shown for you to read.

Security of your information

This service always uses fully encrypted connections, the same security as used in internet banking. If you look at the right of the address bar, you will see a small padlock icon. This indicates that you are using a secure link and that your data is encrypted.

As an additional measure your information is held encrypted until the practice need to view it. It is then sent to the practice still encrypted and only converted to readable text at the practice.

Tracking users

We track how you use our Digital Practice but we don’t collect or store your personal information (e.g. your name or address) while you’re browsing. This means that you can’t be personally identified. We use Google Analytics software to track:

The pages you visit
How long you use the site
How you got to the site and what links you clicked on.

We haven’t given Google permission to share this data with anyone else.

How is the Digital Practice updated?

We are continuously working on this site to make sure that the information is accurate and up to date. The digital practice is also continuously updated based on the results of user testing, feedback from members of the public and from your practice and other practices who are using this system.

Suggestions for improvement of the Digital Practice

We are always looking for ways to improve this service and would welcome your suggestions. Please send your comments to suggestions@siliconpractice.co.uk

Links to external sites

Digital Practice links to external organisations when that service is essential for helping a patient complete a task or when helping patients find a service.

Online Requests

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Leacroft Medical Practice

New Patient Registration

To register with the practice please complete this form.

New Patient Questionniare

New Patient Questionniare

If you are human, leave this field blank.

Have you checked that your are within our practice boundary? *

Yes

No

Please view our practice boundary.

Personal Information

Title: *

Mr

Mrs

Miss

Ms

OtherOther

Gender: *

Male

Female

Other (please state):Other (please state):

Surname: *

First Name(s): *

Previous Surname:

Please Note: The name on this form must exactly match the name on your ID or your application is very likely to be rejected by NHS England.

NHS Number:

Date of Birth *

Please use this format: DD/MM/YYYY

Ethnicity: *

White British

White Irish

White European

Black British

Black African

Mixed Background

Indian or British Indian

Pakistani or British Pakistani

Bangladeshi or British Bangladeshi

OtherOther

I do not wish to state my ethnicity.

Your Current Address: *

Post Code: *

Telephone Number: *

Name of Next of Kin: *

Relationship to Next of Kin: *

Next of Kin Telephone Number: *

Next of Kin Address: *

Previous Details

Previous address in the UK: *

Please include postcode.

Name and address of previous GP: *

Country of Birth: *

Town of Birth: *

If you are from abroad

Registering with the NHS for the first time in the UK

Date you came to live in the UK:

Please use this date format: DD/MM/YYYY

If you are returning from abroad

Previously been registered with the NHS in the UK

Date you left the UK:

Please use this date format: DD/MM/YYYY

Date you returned to the UK:

Please use this date format: DD/MM/YYYY

If you are returning from the Armed Forces

Please state the date of enrolment:

Please use this date format: DD/MM/YYYY

Please state the date of leaving:

Please use this date format: DD/MM/YYYY

Supplementary Questions

I am not ordinarily a resident in the UK

Ordinarily Resident

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

Please select one of the following statements:

I understand that I may need to pay for NHS treatment outside of the GP practice

I understand I have a valid exemption from paying for NHS treatment outside of the GP practice. This includes for example, an EHIC, or payment of the Immigration Health Charge (“the Surcharge”), when accompanied by a valid visa. I can provide documents to support this when requested

I do not know my chargeable status

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate
action may be taken against me.

A parent/guardian should complete the form on behalf of a child under 16.

Signature:

Print Name:

On behalf of:

Relationship to patient:

Date:

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea

Do you live in another EEA Country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?

Yes

No

Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC)?

Yes

No

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

EHIC/PRC

Please enter the details from your EHIC or PRC below.

Country Code:

Name:

Given Names:

Date of Birth:

Please use date format: DD/MM/YYYY

Personal Identification Number:

Identification number of the institution:

Identification number of the card:

Expiry Date:

PRC Validity Period - From:

PRC Validity Period - To:

S1 Form

Do you have an S1 Form?

I have an S1 form (e.g. you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state).

Please give your S1 form to the practice staff.

How will your EHIC/PRC/S1 data be used?

By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

NHS Organ Donor Registration

If you wish your medical records to be marked that you are willing to donate organs/tissue for transplantation after your death; please tick:

Kidneys

Heart

Liver

Corneas

Lungs

Pancreas

Any part of my body

Signature:

Date:

If you would like to join the NHS Organ Donation Register please visit their website on: www.organdonation.nhs.uk/consent.do

NHS Blood Donor Registration

I would like to join the NHS Blood Donor register as someone who may be contacted and would be prepared to donate blood.

Tick here if you haven't given blood in the last 3 years

Signature:

Date:

Phone

Tel
01293 574747

Fax
01293 562955

Location

Langley House Langley Drive Crawley RH11 7TF
Map