If you need your doctor to dispense medicines and appliances (note: not all doctors are authorised to dispense medicines)

Diúltaigh Taifead Sláinte Aonair SNS

Comhfhreagras

Is é an síniú thuas:

For the following questions please answer to the best of your knowledge.

We have provided a basic guide to alcohol content below to assist your completion.

A 750ml bottle of wine contains 10 units.

A standard(175ml) glass of wine contains 2 units.

A single small shot of spirits (25ml) contains 1 unit.

A standard 70cl bottle of spirits contains 28 units.

A pint of 3.6% strength lager/beer/cider contains 2 units.

A pint of 5.2% strength lager/beer/cider contains 3 units.

Please note, we may contact you to offer you support or advice if appropriate based on your submission.

The following information you supply may assist us to provide good care for you whilst we wait for your previous medical records. Is there any of the following in your family (father, mother, brother, sister) under the age of 65 with the following illnesses?

A photo of your passport or driving licence, as proof of your name;

A photo of a recent utility bill or similar, from sometime over the past 3 months, as proof of your current address. Please note that we use these items once for verification when setting up your account, and we delete them as soon as your account is open.

We are committed to promoting access to our services and offering choice wherever possible in the services we provide and the way we deliver them. An acceptable behaviour contract is an individual written agreement between a patient and their GP practice.

Ty Elli Group Practice will ensure you are dealt with fairly and in a courteous and helpful manner. Ty Elli Group Practice will ensure that staff take responsibility for resolving or dealing with your query or that they refer it to an appropriate colleague.

The Conditions: The above-named person applying for registration at the practice agrees to the following: 1. To refrain from using abusive or offensive language, making threats of violence or aggressive behaviour and to treat all staff fairly and with respect; in person, on the phone, in writing or on social media. 2. To refrain from using abusive or offensive language, or threaten other patients. 3. To refrain from damaging any property or write graffiti in and around the surgery. 4. To not act in a manner that causes or is likely to cause harassment, alarm, or distress to Doctors, surgery staff, and other patients. 5. To utilise the practice’s Complaints Process to raise concerns about care or service received, rather than posting anonymous feedback on social media. 6. To cancel any appointments they are unable to attend with as much notice as possible. 7. To adhere to Ty Elli Group Practices DNA (Did Not Attend) policy - if they miss three appointments without notifying the surgery, they may be removed from the practice list and will have to register with a different practice. 8. To adhere to Ty Elli Group Practices, repeat prescription policy and agree to allow 2 working days before collecting repeat prescriptions.

If the above-named person fails to adhere to the above conditions, they may be removed from the practice list. This contract serves as an initial warning in the event of breaches occurring. They may also be reported to the Police, and/or allocated to an alternative primary care service for violent patients where they can only be seen by a Doctor with Police in attendance.