MATTER OF HEALTH

Patient Registration

Please complete each section to register with Matter of Health.

Step 1 of 6 Your details

Your details

Please provide your current personal details.

Legal first name *

Legal surname *

Preferred name

Date of birth *

Email address *

Mobile number *

Home address

Address line 1 *

Address line 2

Town / City *

Postcode *

Identity verification

Please provide identification so that we can verify your identity.

Accepted photo ID

Please upload a valid passport or driving licence.

Photo ID * Accepted formats: PDF, JPG, JPEG or PNG.

Does this photo ID show your current home address? * Yes No

Proof of address required

Please upload proof of your current address dated within the last 3 months, such as a bank statement, utility bill, council tax document or other official correspondence.

Proof of address * Accepted formats: PDF, JPG, JPEG or PNG.

Next of kin

Please provide details for your next of kin.

Full name *

Relationship to you *

Telephone number *

Email address

I understand and agree that Matter of Health may contact my next of kin where there are significant concerns about my safety or wellbeing. *

Your GP details

Please provide the details of the GP practice you are registered with.

GP practice name *

GP name If known.

GP practice address *

GP practice postcode *

GP practice telephone number *

I understand and agree that Matter of Health may contact my GP where there are significant concerns about my safety or wellbeing, and will communicate with my GP where clinically necessary in relation to prescribing and medication management. *

Pharmacy & prescriptions

Important information if you receive medication from us.

If medication is prescribed

If medication is prescribed through Matter of Health, your prescription will be fulfilled through our partner pharmacy, Healistic, unless you tell us that you would prefer to use another pharmacy.

If you would like to use a different pharmacy, please email support@matterofhealth.co.uk with your preferred pharmacy's details.

Terms & declaration

Please review the following before submitting your registration.

I confirm that I have read and agree to Matter of Health's Patient Terms & Conditions . * I confirm that I have read and understood Matter of Health's Privacy Notice . * I confirm that the information provided in this registration form is accurate and complete to the best of my knowledge. *

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MATTER OF HEALTH

Thank you

Your registration has been submitted successfully.

We have received your details. If we need any further information, a member of the Matter of Health team will contact you.

Need anything?

If you have any questions or need to contact us, you can reach our team by email, telephone or WhatsApp.

Email support@matterofhealth.co.uk Call 0333 358 2326 WhatsApp 07449 531750

Patient Registration

Your details

Home address

Identity verification

Next of kin

Your GP details

Pharmacy & prescriptions

If medication is prescribed

Terms & declaration

Thank you

Need anything?

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