What is the Local Form?
We’ve collaborated with NHS E to enhance the national solution by offering a local form that puts you back in control!
Automatically activated for practices at no additional cost, this form builds on the standardised national registration form to capture and code additional data, including health inequalities, special circumstances, and screening data relevant to your practice, all aimed at enhancing patient care.
What Questions Do You Ask?
You can check out the full list of questions we ask under 'Settings' > 'Local Form Settings' on the Hub. Feel free to turn any questions on or off as you like!
Do you live in a residential care home or a nursing home?
What is your religion?
What is your sexual orientation?
Do any of the following apply to you?
This gives options of special circumstances ie. Asylum seeker, Homeless
Who do you care for and how do you provide care for them?
We will only ask this if the patient stated that they are a young, foster, or unpaid carer.
Would you like free carers advice and support?
We will only ask this if the patient stated that they are a young, foster, or unpaid carer.
Would you like free smoking advice and support?
We will only ask this if the patient stated that they smoke cigarettes.
How much exercise do you do?
Pregnancy questions
Are you pregnant?
We will only ask this if the patient stated that they are of the female sex.
What is your due date?
We will only ask this if the patient stated that they are pregnant.
Are you booked in with maternity services?
We will only ask this if the patient stated that they are pregnant.
Which maternity services are you booked in with?
We will only ask this if the patient stated that they are pregnant and booked in with maternity services.
Do you have any family history of these conditions?
If you have previously been registered with a UK Armed Forces GP, what role were you registered as?
We will only ask this if the patient stated that they have previously been registered with a UK Armed Forces GP.
Armed forces enlistment questions
What is your enlistment date to the Armed Forces?
We will only ask this if the patient stated that they have previously been registered with a UK Armed Forces GP.
What date did you or will you leave the Armed Forces?
We will only ask this if the patient stated that they have previously been registered with a UK Armed Forces GP.
What is the best way to contact you when it comes to your medical circumstances?
Can we contact you about updates at the practice?
Would you like to be part of our Patient Participation Group?
Would you like to be tested for HIV?
Would you like to be tested for chlamydia?
If you're interested in having custom local form questions tailored to the specific needs of your practice, click here to make your request!
How Does It Work?
Once a patient finishes completing the NHS E registration form, they'll be seamlessly directed to the local form. This is their chance to share a bit more by answering some extra questions from the practice, helping you get a clearer picture of their health needs.
Check out this quick video explanation and demo from one of our co-founders Raj! 👇
Please note that the local form is optional for patients to complete, and completion rate is currently only 15%. NHS E are looking to improve the placement, we believe a 70% completion rate is possible.
Test the Local Form 📱
Click here to play around with our local form! You’ll discover its features, see how easy it is to use, and learn how it collects valuable health information.