Stethoscope

Old Road | Tean | Stoke-on-Trent | ST10 4AG | telephone: 01538 722 323

Blythe Bridge Primary Health Care

Tean Surgery

 

 

 

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Registration Form

Please note the following terms of use for online registration:

  • You should only send this form if you are sure you are eligible to join the practice
  • Sending this form will not automatically register you with the surgery, it will merely send the completed application for the surgery to process.
  • On your first visit to the surgery, you will be asked to sign the form and provide proof of address.
  • Sending the form does not guarantee you will be accepted on the practice register.
  • A copy of the completed form will be sent to the surgery and the email address you provide.

Personal Data

Please note that by using this form you will be sending personal information over the internet.  The form uses an encrypted connection with https SSL certificates, and every effort is made to keep this information secure. However, we cannot guarantee absolute privacy.  If you have any concerns about electronic submissions then you should use another method of registration.

It should be further noted that no personal information is stored on this website or any servers relating to it.  Once your form is submitted it will emailed to the surgery and all information will be deleted once that process is completed.