Portcullis Surgery

Portcullis Surgery

Portcullis Lane, Ludlow, SY8 1GT

Current time is 11:34 - We're open

NHS

Telephone: 01584 872 939

Fax: 01584 879 031

portcullis.surgery@nhs.net

Registration Form

Please fill in the online form below to register at our practice

Registration Form

To register with our practice, ALL YOU NEED TO DO IS FILL IN THE FORM BELOW AND SUBMIT IT. Or you can print the forms and hand them in to reception or send them by post
  • Please say name of Doctor (if known), address of surgery including postcode and tel no (if known)
    Please tick all those that apply to you
  • If you are not on any medication write none.
  • Please add all relevant tel nos
  • Max. file size: 64 MB.
    Passport or Driver's licence please. Ideally upload a photo straight away with this application or send it to us by email to portcullis.dutymanager@nhs.net. If you don't have either of these IDs, please fill in the form and call us. If you are registering a child a copy of their birth certificate or a parents ID may be acceptable.
  • OPTIONAL ADDITIONAL INFORMATION ABOUT YOURSELF

    Please answer the questions below as fully as possible as it will help with your care.
  • Regardless of when you left the military, please tell us that you’ve served in the UK Armed Forces. This will help our practice to better understand any military related health conditions that you may have and ensure that you are referred, where appropriate, to dedicated services for veterans. Our lead GP for veteran services is Dr Targett.
  • If your GP is made aware of your sexual orientation and gender identity this can help identify your health care needs. Only you can decide if you would like to share with us what sexual identity best describes you. By asking this question we are trying to become more inclusive as a practice and allow patients to self-disclose this information, if you choose to and improve health outcomes as a result Sexual orientation is about who you’re attracted to and who you feel drawn to romantically, emotionally, and sexually. It’s different than gender identity. Gender identity isn’t about who you’re attracted to, but about how you identify yourself — male, female, transgender.
  • Please write a description of what your respect form says
  • Max. file size: 64 MB.
    For close family members (parents, siblings, grandparents, children) Please tick all those that apply to your family
  • (1 session is 30 mins of vigorous activity)
  • Please describe below any additional information you would like to share with us.
  • This field is for validation purposes and should be left unchanged.

Opening Times

  • Monday
    08:30 until 20:00
    6-8pm Pre-booked appointments only.Call 111 for advice OOH
  • Tuesday
    08:30 until 20:00
    6-8pm Pre-booked appointments only.Call 111 for advice OOH
  • Wednesday
    08:30 until 20:00
    6-8pm Pre-booked appointments only.Call 111 for advice OOH
  • Thursday
    08:30 until 18:30
    Call 111 for advice OOH
  • Friday
    08:30 until 20:30
    Open 1-2 Fridays a month. 6-8pm Pre-booked appointments only.Call 111 for advice OOH
  • Saturday
    08:30 until 12:30
    Open 1-2 Sat per month Pre-booked appointments only. Call 111 for advice OOH
  • Sunday
    CLOSED
    Call 111 for advice OOH