New Patient Registration

If you would like to register with the practice please use this form.

To register a new patient you will need to live within our practice boundary.

If you will not be in the area for more than 3 months, you will need to complete a Temporary Resident form.

New Patient Registration

Patient's Details

Is this your first registration with a GP Practice in the UK? *
Will you be in the area for more than 3 months? *
Title *
Please use this date format: DD/MM/YYYY.
Sex *
Any responses we send will go to this email address.
Can we contact you by email?
Marital Status:

Next of Kin

If you have served in the British Armed Forces

Are you reservist?
Is this your first registration with a GP since leaving the Armed Forces?

Ethnicity

Please specify the ethnic group you consider you belong to:
Do you speak English?
Do you read English?
Do you need an interpreter?

Emergency Contact

Are they your next of kin?
Do you give us permission to discuss your medical records with them?

Previous Details

Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK
Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea
Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?
Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) ?

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

EHIC/PRC

Please enter the details from your EHIC or PRC below.

S1 Form

Do you have an S1 Form?
Please give your S1 form to the practice staff.

How will your EHIC/PRC/S1 data be used?

By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

Carers

Do you have a carer?
Are you a carer for someone?
Do you give us permission to discuss your medical record with your carer?