You will need to complete this and then email it to nencicb-ng.a85010@nhs.net or hand into the practice.  Please note this email address should only be used to return your completed form. 

Please also attach a picture of one form of identification (e.g Passport/Driving License) if submitting via email.

Click here for help from the NHS on how to access a range of health and care services from home or on the move using your smartphone, computer or tablet.