Please complete this form and return completed with your GMS1 form. It can take approximately six weeks before we receive your medical records from your previous surgery. By completing the below we will have a good knowledge of your medical history should you wish to see a GP/nurse. All information given will be treated in the strictest of confidence.
Many thanks for completing this questionnaire. If there is anything you would like to know please ask a member of staff or contact the surgery on 0151 525 1298.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key known only to the GP practice and is
accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Stopgate Lane Medical Centre
6 Stopgate Lane, Liverpool, L9 6AP.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.