New patient registrations – additional questions Please complete these additional questions Personal DetailsFirst nameSurnameDate of Birth Day Month Year Gender Female Male Supplementary QuestionsHow do you prefer to be addressed e.g. ‘Bob’ instead of ‘Robert’? Leave empty if no preference OptionalWhich site (surgery) would you like to attend The Valley Surgery Chilwell Meadows Surgery Please note that you will always be seen at this siteHow do you keep fit? Optional
