Forms

Once completed and signed, please either email forms to us (contact.w92025@wales.nhs.uk) or put them in the practice postbox. 

Blood Pressure Diary

Blood Pressure Diary (with instructions)

Consent Forms

Forms for someone to collect information or to speak on your behalf. 

Consent

Carers

Register as a Carer

Change Of Address or contact details

Change of Address or contact information form

Or change your contact details online

Change of Name /Circumstances

Change of Name / Circumstances form

Hywel Dda Adult Weight Management Service

Complete this online form.

Maternity Survey - for those who have given birth since November 2022

Complete this online form - English Cymraeg

Ear Wax Removal (Self Referral for Community Ear Microsuction Clinic)

Complete this online form

Herbert Protocol

The Herbert Protocol is a form that carers, family or friends of a vulnerable person, or the person themselves can fill in. It contains a list of information to help the police if the person goes missing.

More information can be found here.

Self referral to physiotherapy in Ceredigion

Fill in this online form.

If you are completing the form for yourself, please press NEXT for the first question. 

If you have trouble completing the form, please call 01970 635705, or email BGHphysioreferral.hdd@wales.nhs.uk

Subject Access Request form

Cymraeg English

If you are unsure if you need to complete an SAR form, please contact the practice secretaries on 01970 613 500 Option 5.

Please sure all sections are completed and the form is returned to the surgery.