{"id":482,"date":"2018-02-06T09:43:40","date_gmt":"2018-02-06T09:43:40","guid":{"rendered":"https:\/\/islandhealth.co.uk\/?page_id=482"},"modified":"2024-03-19T08:37:00","modified_gmt":"2024-03-19T08:37:00","slug":"forms","status":"publish","type":"page","link":"https:\/\/islandhealth.co.uk\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div id=\"x-section-1\" class=\"x-section\" style=\"margin: 45px 0px 0px;padding: 25px 0px 0px; background-color: transparent;\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-1-1\" style=\"padding: 0px;\" ><h1  class=\"h-custom-headline h1\" ><span>IslandHealth <strong> Forms & Information<\/strong><\/span><\/h1><hr  class=\"x-hr\" style=\"border-top-width: 1px;width: 100%;\"><\/div><\/div><\/div><div id=\"x-section-2\" class=\"x-section\" style=\"margin: 0px 0px 50px;padding: 10px 0px; background-color: transparent;\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-2-3\" style=\"padding: 15px; background-color:hsla(218, 24%, 87%, 0.74);\" ><h5  class=\"h-custom-headline h5 accent\" ><span><strong>Forms<\/strong>:<\/span><\/h5><hr  class=\"x-gap\" style=\"margin: 20px 0 0 0;\"><ul id=\"\" class=\"x-ul-icons\" style=\"margin-bottom: 45px; font-size: 1.8em; font-weight: 300;\" ><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/new-patient-registration-form\/\" title=\"\" target=\"\">New Patient Registration Form<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/new-patient-registration-form-u16\/\" title=\"\" target=\"\">New Patient Registration Form U16<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/new-baby-registration-form\/\" title=\"\" target=\"\">New Baby Registration Form<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2023\/07\/Seasonal-Worker-Registration-Form-180723.pdf\" title=\"\" target=\"\">Seasonal Worker Registration Form<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/inter-practice-registration-for-patient-for-referral\/\" title=\"\" target=\"\">Inter Practice Registration For Patient For Referral<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/change-of-address-form\/\" title=\"\" target=\"\">Change Of Address<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/travel-vaccination-form\/\" title=\"\" target=\"\">Travel Vaccination Form<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"display: none;\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2019\/06\/IH-Booklet-2017.pdf\" title=\"\" target=\"\">New Item<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2021\/03\/subjectaccessrequestpdf-1.pdf\" title=\"\" target=\"\">Subject Access Request<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2023\/04\/Menopause-Symptom-Questionnaire2.pdf\" title=\"\" target=\"_blank\">Menopause Symptom Questionnaire<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2023\/08\/IH-Headache-pre-assessment-form-and-headache-diaries.pdf\" title=\"\" target=\"_blank\">Headache Clinic Assessment Form<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/visitor-form\/\" title=\"\" target=\"\">Visitor Form - England, Scotland, Wales & Northern Ireland<\/a><\/li><li id=\"\" class=\"x-li-icon\" style=\"\" ><i class=\"x-icon-wpforms\" aria-hidden=\"true\" style=\"\" data-x-icon-b=\"&#xf298;\" ><\/i><a href=\"https:\/\/islandhealth.co.uk\/forms\/visitor-form-row\/\" title=\"\" target=\"\">Visitor Form - Jersey, Sark, Isle of Man & Rest Of World<\/a><\/li><\/ul><\/div><div  class=\"x-column x-sm x-1-3\" style=\"padding: 15px; background-color:hsla(218, 24%, 87%, 0.74);\" ><h5  class=\"h-custom-headline h5 accent\" ><span>Surgery Hours<\/span><\/h5><div id=\"\" class=\"x-text\" style=\"\" ><p><strong>Mon - Fri<\/strong> -  8.00am - 6.00pm<br \/>\n<strong>Sat<\/strong> - 8.00am - 12.00pm at St Sampsons<br \/>\n<strong>Thurs<\/strong> until 7pm at Town Surgery<\/p>\n<\/div><h5  class=\"h-custom-headline h5 accent\" ><span>Contact Us<\/span><\/h5><div id=\"\" class=\"x-text\" style=\"\" ><p><strong>L'Aumone Surgery <\/strong><br \/>\n(+44 1481)  256517<br \/>\n<strong>St Sampson's Surgery <\/strong><br \/>\n (+44 1481)  245915<br \/>\n<strong> Town Surgery <\/strong><br \/>\n(+44 1481) 724747<\/p>\n<\/div><h5  class=\"h-custom-headline h5 accent\" ><span>Pay Online<\/span><\/h5><hr  class=\"x-gap\" style=\"margin: 30px 0 0 0;\"><a  class=\"x-btn x-btn-flat x-btn-square x-btn-regular x-btn-block\"  href=\"https:\/\/islandhealth.co.uk\/online-payment-facility\/\"     data-options=\"thumbnail: ''\">Online Payment Facility<i  class=\"x-icon mvn mls mrn x-icon-arrow-right\" data-x-icon-s=\"&#xf061;\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div><\/div><div id=\"x-section-3\" class=\"x-section\" style=\"margin: 0px;padding: 45px 0px; background-color: hsla(218, 24%, 87%, 0.74);\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm cs-ta-center x-1-1\" style=\"padding: 0px; background-color:hsla(0, 0%, 0%, 0);\" ><h2  class=\"h-custom-headline cs-ta-center h3\" ><span><strong>Complaints & Suggestions<\/strong><\/span><\/h2><div id=\"\" class=\"x-text cs-ta-center\" style=\"\" ><p>The doctors, other practitioners and staff of IslandHealth make every effort to provide the highest standard of treatment and care to patients and their families.<br \/>\nSometimes you may feel that we have fallen short of this ideal or that the system has not provided what you require.<br \/>\nWe appreciate any constructive suggestions that you may have and have a robust complaints procedure that ensures any issues raised are appropriately investigated.<\/p>\n<p><strong> Suggestions<\/strong><br \/>\nIf you have any suggestions for improving the way the practice operates, please please click the following link :<\/p>\n<p><a href=\"https:\/\/islandhealth.co.uk\/suggestions-form\/\">Suggestions form<\/a><\/p>\n<p>You can also put them in writing addressed to: Mr. Andrew Carey, Practice Manager, St Sampsons Medical Centre, Grande Maisons Road, St Sampson\u2019s, Guernsey, GY2 4JS.<\/p>\n<p>Furthermore, if you are unhappy with any aspect of our service or your treatment, please contact the practice manager or your doctor, who will be happy to listen to your suggestions or criticisms.<\/p>\n<p><strong>Complaints<\/strong><br \/>\nPlease click on the link below to see our complaints procedure.<br \/>\n<a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2021\/03\/complaints-procedure.pdf\">Complaints Procedure<\/a><\/p>\n<\/div><span class=\"x-image e482-e38 mde-0\"><img decoding=\"async\" src=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2021\/06\/AJC-Website-Photo-2.jpg\" width=\"290\" height=\"193\" alt=\"Image\" loading=\"lazy\"><\/span><div id=\"\" class=\"x-text cs-ta-center\" style=\"\" ><p><strong>Practice Manager<\/strong><br \/>\nMr. Andrew Carey is our practice manager and he is in charge of the administration and efficient running of the practice.<br \/>\nHe will be pleased to assist you with any concerns.<\/p>\n<\/div><\/div><\/div><\/div><div id=\"x-section-4\" class=\"x-section\" style=\"margin: 0px;padding: 45px 0px; background-color: transparent;\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-1-1\" style=\"padding: 0px;\" ><h2  class=\"h-custom-headline cs-ta-center h3\" ><span>Island<strong>Health<\/strong> Privacy Notice<\/span><\/h2><div id=\"\" class=\"x-text cs-ta-center\" style=\"\" ><p>Healthcare professionals who provide you with care are required by law to maintain records about your health and any treatment or care you have received. These records help us to provide you with the best possible medical care. This privacy notice explains why IslandHealth collects information about patients and how we keep it safe and confidential, and how that information may be used.<\/p>\n<p><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2023\/07\/Fair-Processing-Privacy-Notice-Jul23.pdf\">IslandHealth Privacy Notice<\/a><br \/>\n<a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2020\/06\/Privacy-Notice-for-SMSL-May-2019.pdf\">SMSL Privacy Notice<\/a><\/p>\n<\/div><\/div><\/div><\/div><div id=\"x-section-5\" class=\"x-section\" style=\"margin: 0px;padding: 45px 0px; background-color: hsla(218, 24%, 87%, 0.74);\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-1-1\" style=\"padding: 0px; background-color:hsla(0, 0%, 0%, 0);\" ><h2  class=\"h-custom-headline cs-ta-center h3\" ><span><strong>Subject Access Requests<\/strong><\/span><\/h2><div id=\"\" class=\"x-text cs-ta-center\" style=\"\" ><p>Under the Data Protection (Bailiwick of Guernsey) Law 2017, you are entitled to request a copy of the information the Practice holds about you.<\/p>\n<p>The best way to do this is by completing the form below as it ensures we have all the information required to process your application \u2013 this process is known as making a \u2018subject access request\u2019.<\/p>\n<p><a href=\"https:\/\/islandhealth.co.uk\/wp-content\/uploads\/2021\/03\/subjectaccessrequestpdf-1.pdf\">Subject Access Request Form<\/a><\/p>\n<p>Once completed the form can be emailed, posted or dropped in to any of our surgeries.<br \/>\nMost requests will be processed within one month, unless they are identified as complex, in which case the Practice has three months to complete the request.<br \/>\nIf you require help completing this form or for further information regarding subject access requests please<a href=\"https:\/\/islandhealth.co.uk\/contact-us\/\" rel=\"noopener\" target=\"_blank\"> contact us<\/a>. <\/p>\n<\/div><\/div><\/div><\/div><div id=\"x-section-6\" class=\"x-section\" style=\"margin: 0px;padding: 45px 0px; background-color: hsla(0, 0%, 0%, 0);\" ><div id=\"\" class=\"x-container max width\" style=\"margin: 0px auto;padding: 0px;\" ><div  class=\"x-column x-sm x-1-1\" style=\"padding: 0px;\" ><h2  class=\"h-custom-headline cs-ta-center h3\" ><span><strong>Useful Links<\/strong><\/span><\/h2><div id=\"\" class=\"x-text cs-ta-center\" style=\"\" ><p><a href=\"https:\/\/www.cognitivetherapyguernsey.gg\" rel=\"noopener\" target=\"_blank\"> Cognitive Behavioural Therapy Guernsey<\/a><br \/>\n<a href=\"http:\/\/www.gov.gg\/healthyliving\" rel=\"noopener\" target=\"_blank\">Healthy Living - Gov.gg<\/a><br \/>\n<a href=\"http:\/\/www.parkrun.org.uk\/guernsey\" rel=\"noopener\" target=\"_blank\">Guernsey Park Run<\/a><br \/>\n<a href=\"http:\/\/www.gov.gg\/healthyminds\" rel=\"noopener\" target=\"_blank\">Healthy Minds<\/a><br \/>\n<a href=\"http:\/\/www.patient.info\" rel=\"noopener\" target=\"_blank\">Patient.info (Patient Information Leaflets)<\/a><br \/>\n<a href=\"http:\/\/health connections.gg\" rel=\"noopener\" target=\"_blank\">Health Connections<\/a><br \/>\n<a href=\"http:\/\/iscp.gg\/article\/117806\/If-you-are-concerned-about-a-child-in-Guernsey-or-Alderney\" rel=\"noopener\" target=\"_blank\">Child Protection Guernsey<\/a><br \/>\n<a href=\"https:\/\/sites.google.com\/carers.gg\/carers\/\" rel=\"noopener\" target=\"_blank\">Carers Guernsey<\/a><br \/>\n<a href=\"https:\/\/www.samaritans.org\/branches\/guernsey\/\" rel=\"noopener\" target=\"_blank\">Samaritans Guernsey<\/a><br \/>\n<a href=\"https:\/\/www.guernseymind.org.gg\" rel=\"noopener\" target=\"_blank\">Guernsey Mind<\/a><br \/>\n<a href=\"https:\/\/www.msg.gg\" rel=\"noopener\" target=\"_blank\">Medical Specialist Group LLP Guernsey<\/a> <\/p>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>IslandHealth Forms &#038; InformationForms:New Patient Registration FormNew Patient Registration Form U16New Baby Registration FormSeasonal Worker Registration FormInter Practice Registration For Patient For ReferralChange Of AddressTravel Vaccination FormNew ItemSubject Access RequestMenopause Symptom QuestionnaireHeadache Clinic Assessment FormVisitor Form &#8211; England, Scotland, Wales &#038; Northern IrelandVisitor Form &#8211; Jersey, Sark, Isle of Man &#038; Rest Of WorldSurgery HoursMon &#8211; Fri &#8211; 8.00am &#8211; &#8230; <a href=\"https:\/\/islandhealth.co.uk\/forms\/\" class=\"more-link\">Read More<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blank-4.php","meta":{"footnotes":""},"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/pages\/482"}],"collection":[{"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/comments?post=482"}],"version-history":[{"count":18,"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/pages\/482\/revisions"}],"predecessor-version":[{"id":6589,"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/pages\/482\/revisions\/6589"}],"wp:attachment":[{"href":"https:\/\/islandhealth.co.uk\/wp-json\/wp\/v2\/media?parent=482"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}