Patient Survey

We would be very grateful if you could fill in this year’s patient survey, many thanks

Key information summary

Key information summary (KIS) has been designed to support patients who have complex care needs or long term conditions. KIS allows important information to be shared with Healthcare Professionals in unscheduled care in NHS 24, A&E, Scottish Ambulance Service, Out of Hours Service, Hospital and Pharmacy environments.

This can also identify patients who are at high risk of severe illness, and who may need to shield due to COVID-19.

Help us to keep your information up to date. Please complete the form below with your details.

Key Information Summary

Patient’s Details

Enter Email
Please use format day/month/year e.g. 12/05/1979
Is there a keysafe in use? *

Patient’s Next of Kin

Is this the person we should contact in an emergency *

Power of Attorney (POA)

Is there a POA in place? *

Patient’s Care

Are there carers in place?

Privacy Policy

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 Privacy Policy to discover how we protect and manage your submitted data.