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General Health Advice
Antibiotic Awareness
When to use Antibiotics
Back problems
Cough? Self-help guide
Diarrhoea and Vomiting – Dos and Don’ts
Falls risk screening
Managing your Infection
Melanoma Action and Support Scotland
Menopause
More about Sprains and Strains
My Live Well with Pain
Scotland’s Health and Care News Channel
Strong painkillers and Driving
Testicular lumps and swellings
Testicular Cancer – Check Yourself
Vitamin B12 or folate deficiency anaemia
Lifestyle Changes
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Physical Activity – The Single best Medicine
Social Prescribing
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Weight Management
Obesity
Healthy Eating
Eatwell Guide
Food allergy
Food and Nutrition
Food Standards Scotland
Long Term Conditions
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Breast Cancer (female)
Dementia
Dementia Care and Support
Dementia with Lewy bodies
Making Space
Diabetes
Type 1 Diabetes
Type 2 Diabetes
Diabetic retinopathy
Epilepsy
High Blood Pressure (Hypertension)
Heart Disease
My Lungs My Life – Inhalers
Osteoarthritis
Prostate Cancer
Transient Ischaemic attack (TIA)
Support and advice for your heart condition
Mental Wellbeing
Anxiety
Antidepressants
Breathing Space – Feeling Low, Anxious or Stressed?
Depression
Feeling down or anxious? Beating the Blues 24/7 can help…
Five steps to mental wellbeing
Lifelink
Managing emotional effects
Mental Health – General advice
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Rethink Mental Illness
SAMH – For Scotland’s Mental Health
Samaritans
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Newborn Hearing Test
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Annual Health Check
Flu Vaccination
Pneumococcal vaccine for adults
Screening Services
Shingles
Sexual Health & Sexuality
Contraceptive Advice
Getting and using Contraception
Free Condoms
Gender Dysphoria
LGBT Helpline Scotland information and support
Sexual Health Scotland
Sexually transmitted disease
Help & Support in your Area
Ayrshire Baby Loss Support
East Ayrshire Works
East Ayrshire Lisalanna Short Breaks Svc
East Ayrshire Council
Help and Support Organisations
Amina – The Muslim Women’s Resource Centre
Asbestos
Age UK
Chest Heart & Stroke Scotland
MND Scotland
Health Unlocked
MS Society
Other useful links
Orchid – Fighting Male Cancer
Over 60 + or have a Disability? Eligible for free bus travel
Parkinson’s Disease
Ready Scotland
Same You
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We are with you
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#hellomynameis
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‘ Just in Case ‘ medicines
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Care information Scotland
Carers Scotland
East Ayrshire Carers Centre
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Sexual Health Ayrshire
Information for young people using NHS services
Bitesize
See Me
Quarriers
Teenage Friendly
Think Positive about Student Mental Health
The Mix
Young Scot
Ypeople
Your Record
Health Review Forms
Alcohol Consumption Review Form
Asthma Review Form
Blood Pressure Review Form
Breathlessness Review Form
Epilepsy Review Form
Male Urinary Tract (IPSS) Review Form
Mental Health Review (PHQ-9) Form
Smoking Review Form
Travel Risk Assessment Form
Keep us up to date
Change of Contact Details Form
Register as a Carer Form
Register for Online Services Form
Summary Care Record Opt-out Form
News
Menu
Home
About Us
Contact
Contact Telephone Numbers
Location
Opening hours
What to do when we are closed
Send a Message
Making the most of your Practice
Our Team
Allied Health Professionals
Doctors
Nurses
Practice Administration Team
Pharmacotherapy
Practice Policies
At the Practice
Baby Friendly
Accessible Information Standard
Chaperones
Chaperone Policy
Clinical Governance
Clinical Research
Consent Protocol
Disability Access
Duty of Candour
Equality and Diversity
Infection Control Statement
Non-Smoking Premises
Quality Assurance
Removal of Patients from our List
Shared Decision Making
Social Media
Unacceptable Actions Policy
Zero Tolerance
Data
eHealth
Freedom of information
How NHS Scotland manages your Data
Patient Record
Accessing your Record
Access for Others
Subject Access Requests (SAR)
Subject Access Request (SAR) – Request your Records
Data Sharing Preferences
Emergency Care Summary Record
Multi-Disciplinary Teams
Organ Donation Scotland
Sharing your information with Others
How we use your Data
Confidentiality
Privacy Policy
Online Access
Proxy Access – Guidance
Patient Rights
Complaints, Compliments & Suggestions
Entitlement to NHS Treatment
Healthcare for refugees, asylum seekers and overseas visitors
NHS Patient Rights
NHS Services – Rights & Responsibilities
NHS Scotland – How it works
Patient Advice and Support Service (PASS)
Website
Accessibility
Cookie Policy
Disclaimer
Copyright
Appointments, Tests & Referrals
Appointments
Book an Appointment
Cancel an Appointment
Extended Opening Hours
Get Immediate Help from Your Pharmacist
Get Immediate Help for Minor Injuries
Help with your GP Appointment
Self-Referral Services
Care equipment and adapting your home
Community Connector
Ayrshire Council on Alcohol
Addaction – East Ayrshire Recovery Service
Speech and Language Therapist
East Ayrshire Citizens Advice Bureau
Your Hospital Appointment – Confirm, Change or Cancel
Podiatry Services
Sexual Health Ayrshire
Stop Smoking – Quit your Way
Weigh to go Ayrshire
Mental Health Practitioner
Physiotherapy (Musculoskeletal disorders)
Penumbra – Mental Health Support
Sleep Scotland
See a Doctor or Healthcare Clinician
Tests & Investigations
Access Your Test Results
Blood Test-information
Other Common Tests
Urine Tests
Tests and Treatments
X-Rays & Scans
Referral for Further Care
Referral to Hospital by your GP
Your Hospital Appointment – Confirm, Change or Cancel
Who do I See?
Clinics & Services
Clinics
Antenatal Care
Child Health Checks
Diabetes Services & “My Diabetes My Way “
Our Clinics
Travel Clinic & Holiday Vaccinations
Online Services
Practice Services
Chronic Medication Service
Dementia Services
Interpreting Service
Get a Sick or Fit Note
Hepatitis B Immunisation
Home Visits
Housebound & Older People
Non NHS Services – Chargeable
Order a Repeat Prescription
Wasted Medications
Antibiotic Use
Patient Transport Service
Pharmacy Collection Service
Register with us as a New Patient
Temporary Services
Registration Policy
Services for Carers
Your Care
Bereavement
At a Loss
Cruse Bereavement Care Scotland
What to do after Death
Disability
Autism
Action on Hearing Loss
British Deaf Association
Capability Scotland
Disability information Scotland
Disability Rights UK
Enable Scotland
Hearing Loss
Learning Disabilities
National Autistic Society
Sense Scotland
Vision Impairment
Wheelchair users and Disabled People
Health & Wellbeing
Children’s Health
Childline
Change4Life
ERIC – The Children’s Bowel & Bladder Charity
Healthy Start – Vitamins in Scotland
Triple P – Positive Parenting Programme
Your Guide to Coughs, Colds, Earache & Sore Throats for your Child
Vaccination Schedule for Children
General Health Advice
Antibiotic Awareness
When to use Antibiotics
Back problems
Cough? Self-help guide
Diarrhoea and Vomiting – Dos and Don’ts
Falls risk screening
Managing your Infection
Melanoma Action and Support Scotland
Menopause
More about Sprains and Strains
My Live Well with Pain
Scotland’s Health and Care News Channel
Strong painkillers and Driving
Testicular lumps and swellings
Testicular Cancer – Check Yourself
Vitamin B12 or folate deficiency anaemia
Lifestyle Changes
Alcohol & Drug Services
Physical Activity – The Single best Medicine
Social Prescribing
Stop Smoking Service
Weight Management
Obesity
Healthy Eating
Eatwell Guide
Food allergy
Food and Nutrition
Food Standards Scotland
Long Term Conditions
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Breast Cancer (female)
Dementia
Dementia Care and Support
Dementia with Lewy bodies
Making Space
Diabetes
Type 1 Diabetes
Type 2 Diabetes
Diabetic retinopathy
Epilepsy
High Blood Pressure (Hypertension)
Heart Disease
My Lungs My Life – Inhalers
Osteoarthritis
Prostate Cancer
Transient Ischaemic attack (TIA)
Support and advice for your heart condition
Mental Wellbeing
Anxiety
Antidepressants
Breathing Space – Feeling Low, Anxious or Stressed?
Depression
Feeling down or anxious? Beating the Blues 24/7 can help…
Five steps to mental wellbeing
Lifelink
Managing emotional effects
Mental Health – General advice
Mental Health & Money Advice
Mind – For better Mental Health
Rethink Mental Illness
SAMH – For Scotland’s Mental Health
Samaritans
SANE
Scottish Mental Health Service for Deaf People
Suicidal?
Pregnancy & Baby
Baby Box
CRY-SIS Helpline
Diagnostic tests in Pregnancy
Newborn Hearing Test
Postnatal Care
Postnatal Depression
Pregnancy and Baby Payment
Ready Steady Baby!
Women and Families Maternal Mental Health Pledge
Preventative Medicine
Annual Health Check
Flu Vaccination
Pneumococcal vaccine for adults
Screening Services
Shingles
Sexual Health & Sexuality
Contraceptive Advice
Getting and using Contraception
Free Condoms
Gender Dysphoria
LGBT Helpline Scotland information and support
Sexual Health Scotland
Sexually transmitted disease
Help & Support in your Area
Ayrshire Baby Loss Support
East Ayrshire Works
East Ayrshire Lisalanna Short Breaks Svc
East Ayrshire Council
Help and Support Organisations
Amina – The Muslim Women’s Resource Centre
Asbestos
Age UK
Chest Heart & Stroke Scotland
MND Scotland
Health Unlocked
MS Society
Other useful links
Orchid – Fighting Male Cancer
Over 60 + or have a Disability? Eligible for free bus travel
Parkinson’s Disease
Ready Scotland
Same You
Scottish Refugee Council
Shelter – Scotland
Social Care & Support
Telecare – Try our self check online tool
Turning Point Scotland
Touched by Suicide Scotland
The Pavement
The Brain Tumour Charity
We are with you
Self Help Guides
Palliative Care information
Cancer in children and young people
Cancer Support Services
End of Life Care
#hellomynameis
Babies, children and young people
‘ Just in Case ‘ medicines
Questions and concerns about end of life care
Together for Short Lives
Supporting Others
Are you a Carer?
Care information Scotland
Carers Scotland
East Ayrshire Carers Centre
Young People
Sexual Health Ayrshire
Information for young people using NHS services
Bitesize
See Me
Quarriers
Teenage Friendly
Think Positive about Student Mental Health
The Mix
Young Scot
Ypeople
Your Record
Health Review Forms
Alcohol Consumption Review Form
Asthma Review Form
Blood Pressure Review Form
Breathlessness Review Form
Epilepsy Review Form
Male Urinary Tract (IPSS) Review Form
Mental Health Review (PHQ-9) Form
Smoking Review Form
Travel Risk Assessment Form
Keep us up to date
Change of Contact Details Form
Register as a Carer Form
Register for Online Services Form
Summary Care Record Opt-out Form
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*
Last Name
*
Email
*
Enter Email
Confirm Email
*
Confirm Email
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Gender
*
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Date of Departure
*
Please use format day/month/year e.g. 12/05/2019
Date of Return
*
Please use format day/month/year e.g. 12/05/2019
Please give details of country to be visited, length of stay, and how remote you’ll be from medical help
*
Type of trip
*
Business
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Other
Holiday type
*
Package
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Camping
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Accommodation
*
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*
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*
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*
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Other
Do you have any recent or past medical history of note? (including diabetes, heart or lung conditions)
*
List any current or repeat medications
*
Do you have any allergies for example to eggs, antibiotics, nuts?
*
Have you ever had a serious reaction to a vaccine given to you before?
*
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Don’t Know
Does having an injection make you feel faint?
*
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No
Don’t Know
Do you or any close family members have epilepsy?
*
Yes
No
Don’t Know
Do you have any history or mental illness including depression or anxiety?
*
Yes
No
Don’t Know
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
*
Yes
No
Don’t Know
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
*
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No
Don’t Know
Please type below any further information which may be relevant:
Have you ever had any of the following vaccinations / malaria tablets?
*
Tetanus
Polio
Diptheria
Typhoid
Hepatitis A
Hepatitis B
Meningitis
Yellow Fever
Influenza
Rabies
Jap B Enceph
Tick Borne
Other / Malaria tablets
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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
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