EVENING & WEEKEND APPOINTMENTS now AVAILABLE. See APPOINTMENTS - CARE NAVIGATION left menu +++ Volunteers@SAMC: Could you offer support to individual patients? Tasks like BEFRIENDING, offering practical and emotional support, DRIVING to/from activities. See page COMMUNITY@SAMC for more information.

Forms for Patients

Forms for you to access and download by clicking title. 

1. ADULT Patient Registration form
To be completed by patients wanting to register at SAMC.

1.1 CHILD UNDER 16 Registration form
To be completed for patients under 16 wanting to register at SAMC.

1.2 CARE HOME Patient Registration form
To be completed for patients residing in care homes.


2. Travel Clinic form
To be completed by patients needing vaccinations.

3. Patient details change form
To be completed by patients to adivse us of a change to contact details.

8. Feedback form
To be completed by patients wanting to send us feedback on our services. (A formal complaint formal is available - see below).

12. Consent for Minor Surgery form

To be completed by patients prior to undertaking a minor surgery procedure at SAMC.

17. Asthma Annual Review
To be completed by patients prior to attending their annual review.

19. Application for access to Health Records - Subject Access Request (SAR)
To be SAMC by patients requesting access to their medical records.

23. Patient online access for prescriptions & appointments form
To be completed by patients wanting to use SAMC online & other services.

28. Existing patients access to online medical records
To be completed by patients wanting to access summary medical records online.

31. Complaint procedure and form
Can be completed by a patient wishing to raise a formal complaint.

33. Urine sample form
To be completed by patients leaving a urine sample for testing.

 

 

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