Patient Behavior Contract

Patient Acceptable Behaviour Contract


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.

The contract is between (the patient / patients representative):








and The Wall House Surgery (the practice)  and is valid from the date shown in the signature table below.

 We will ensure you are dealt with quickly, fairly and in a courteous and helpful manner.

We 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 make reasonable request of the practice within reasonable times frames.

3.    To not make personal allegations or comments about practice staff on social media or in third party communications.

4.    To utilise the practice’s Complaints Process to raise concerns about care or service received, rather than posting anonymous feedback on social media.

5.    To cancel any appointments they are unable to attend with as much notice as possible.

6.    As per The Wall House Surgery’s 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.

7.    To adhere to The Wall House Surgery’s repeat prescription policy and agree to allow 5 working days before collecting repeat prescriptions.


Breach of this Contract:

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.


If the breach occurs by a patient’s representative who has signed this form, then we may ask the patient to provide a different representative.



I confirm that I understand the meaning of this contract and that the consequences of breaking the conditions of the contract.









If not the patient completing this form, then please provide the patients name and DOB below:


Patients Name



Date of Birth