Forms and Leaflets

The following forms and leaflets are available to download and print off on your computer.  Just click on the form required:

Carers Registration Form 

Change Of Address

Choice Form For Summary Care Record

Choice Of GP Practice and Out Of Area Registered Patients 
(Must be accompanied by a completed Registration Pack for each patient requesting Out of Area Registration)

Complaints Leaflet

Patient Complaint Form

Third Party Patient Complaint Form

Ear wax self guidelines for patients
Guidance for Patients

Fees 2018 (Including Travel Vaccination Charges)

Gift Aid Declaration
For Minchinhampton Surgery Trust

Minch Surgery Application Form

Patient Consent To Share Information With Carer Form 

Patient Online Information Leaflet
For online appointment booking and repeat prescription requests. Please note pin numbers MUST be collected in person with photo ID

Patient Online Access form

PPG leaflet

Practice Charter

Patient Information Leaflet 2019

GMS1 registration form 

Minch Registration Pack New*

Minch Registration Pack U16s – New*

(* Please also complete a GMS1 registration form)

Statement of Equal Opportunity for Patients at Minchinhampton Surgery

Transport leaflet for patients
Information about the Patient Participation Group’s Transport scheme

Travel Questionnaire
Please complete and return to the Surgery preferably 6 weeks before travel

Oral Glucose tolerance Test

Zero Tolerance Policy

Sexual Health leaflet 2020

Contact Details

Appointments 01453 883793
Repeat Prescriptions (8:30am - 10:30am) 01453 883793
Fax: 01453 731670

The surgery is open for pre-booked appointments only at the moment. Please contact us to make an appointment and we will be happy to help. PLEASE DO NOT TURN UP AT THE SURGERY WITHOUT AN APPOINTMENT. We will continue to operate strict social distancing measures to ensure your safety and to protect our staff and any changes to our policy will be notified via the website and by text messages. Thank you.