Student Medical Services Registration

Student Medical Services Registration

Patient’s Details

Please complete text boxes as accurately as possible and select options where appropriate. Please ONLY use this form if you are already registered with a Leicestershire based GP surgery or you are University of Leicester Staff and do not want to de-register from your current registered GP surgery.

If you are new to the area/country please complete our Full Registration Application form.

Are you attending the University of Leicester as *
By completing this form I am confirming that I am aware, that I will be registered with Victoria Park Health Centre as a temporary patient for student services purposes only. I will continue to remain registered with my current Leicestershire GP practice for my general health care and this care at Victoria Park Health Centre will be ended after 2 months. *
Include Flat, Room, Block Number and House Name
Enter Email
Confirm Email

Patient’s Current GP Details

Please help us trace your previous medical records by providing the following information.

Patient Record Sharing – Electronic Data Sharing Module (EDSM)

Healthcare places can usually share information from your records by letter, email, fax or phone but this can slow down your treatment or mean information is hard to access. You can now choose to share your record electronically bewtween many of the community health services and GP practices in Leicester, Leicestershire and Rutland.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

Please note: There is a slight delay after submitting this form while the information is processed. Please wait for the confirmation of successful submission message before closing this page or navigating away.