Forms

Online Forms

Please note:

Online forms can take up to 5 working days to be attended to, For anything urgent please telephone the surgery.

New Registration Form

Change of Personal Details Form

Self-registration form for maternity care

 

This form can either be printed and completed as a paper copy or edited as an electronic copy.  Please complete the form as thoroughly as you can.  Once completed an electronic copy can be sent securely to bht.maternityreferrals@nhs.net or if you prefer it can be posted to us at:

               

               

Community Midwives,

                c/o Wycombe Birth Centre,

                Wycombe Hospital,

                Queen |Alexandra Road,

                High Wycombe, Bucks. HP11 2TT

 

If you chose to post your registration form please follow this up with a phone call to ensure that we have received it; our number is 01494 425172 Monday – Friday 08:30 – 16:00.

 

If you have any further queries, please do not hesitate to contact the Community Midwives Office using the telephone number above.

 

Self registration form v10 ooa included.docx

Asthma Review Form

Travel Risk Assessment Form

Register For Online Services

Request to change GP Form

Complaints and Compliments Form

Making a complaint is never easy but before you do please make sure that you have a valid reason (please think what is deliverable from the surgery and while we like to treat all patients as individuals sometimes a process needs to be in place so all patients can access our services based on a clinical need) to complain and that you’re someone with a right to complain.

If you’re complaining on behalf of someone else, you’ll usually have to include their written permission. If they can’t give permission, for example, because they are too ill, explain this in your details.

Keep your complaint to the point and as short as possible.

Try to work together with Hughenden Valley Surgeries as far as possible to sort out the problem.

List clearly the things you’re complaining about. Write them down in date order, with as many factual details that you can. For example, if you are complaining about the behaviour of your GP at an appointment, write down:

  • the date and place of the appointment
  • the name of the GP
  • the names of anyone else who witnessed the unacceptable behaviour.

Back up everything that you write - keep any documents you get.

Write the complaint in an unemotional way. Don’t make personal attacks on the staff you are complaining about - stick to complaining about the aspects of their behaviour that are unacceptable.

State the outcome you’re hoping for. This could be just an apology and an undertaking to behave differently in the future.

receiving a complaint is never easy for us as this would suggest that someone is unhappy with the service that they have received but we do use complaints to help us see what we could improve.

Complaints and Compliments Form

Out of Area Registration Form

Online Blood Pressure Reading Form

Provide Blood Pressure Reading

Take your blood pressure, using an accurate device, whilst seated with your arm and back supported, legs uncrossed and whilst you are not talking.

The first time you measure your blood pressure measure on both arms. In future use which ever arm gives the higher result. Inform you GP if there is a difference between the two arms of >20.

Take two readings a minute apart. Should there be a substantial difference measure a third time. The lowest of the readings is the most accurate.

Measure blood pressure morning and evening for seven days. You can document you readings on this Form. You can take the form to your Surgery or preferably send the readings to your GP using this online form.

Please select the surgery you are from below and use the form to provide us with your home blood pressure reading. If you measured your blood pressure more than once then enter the different readings into the table and the web-page will calculate the average for you.

If your blood pressure machine displays your heart rate then please enter it on the form.

We aim to have your doctor review the blood pressure reading within three working days, but at busy times it may take longer.