Child details

Please provide your child's current personal details.

Legal first name *

Legal surname *

Preferred name

Date of birth *

Home address

Address line 1 *

Address line 2

Town / City *

Postcode *

2

Child identity

Please provide identification so that we can verify your child's identity.

Accepted identity documents

Please upload your child's passport, birth certificate or another official document confirming their identity.

Child identity document * Accepted formats: PDF, JPG, JPEG or PNG.

3

Parent / carer details

Please provide details for the parent or carer completing this form.

Full name *

Relationship to child *

Email address *

Mobile number *

Do you live at the same address as the child? * Yes No

Parent / carer address

Address line 1 *

Address line 2

Town / City *

Postcode *

4

Parental responsibility

Please tell us about parental responsibility and any relevant legal arrangements.

Do you have parental responsibility for the child? * Yes No

Who else has parental responsibility for the child?

Are there any court orders, child arrangement orders, restrictions, disputes or other legal arrangements relating to the child? * Yes No

Please provide details *

5

Parent / carer identity

Please provide identification so that we can verify the identity of the person completing this form.

Accepted photo ID

Please upload a valid passport or driving licence.

Parent / carer 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.

6

Child's GP details

Please provide the details of the GP practice your child is 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 child's GP where there are significant concerns about their safety or wellbeing, and will communicate with their GP where clinically necessary in relation to prescribing and medication management. *

7

Pharmacy & prescriptions

Important information if your child receives medication from us.

If medication is prescribed

If medication is prescribed through Matter of Health, your child's 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.

8

Terms & declaration

Please review the following before submitting your child's 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. * I confirm that I am authorised to provide the information in this form and to register this child with Matter of Health. *

Child & Young Person Registration

Child details

Home address

Child identity

Parent / carer details

Parent / carer address

Parental responsibility

Parent / carer identity

Child's GP details

Pharmacy & prescriptions

If medication is prescribed

Terms & declaration

Thank you

Need anything?

STAY UPDATED

SUPPORT

CONTACT

URGENT HELP