New Patient Registration

Practice Catchment Area

Have you checked that you live within our practice catchment area? *

Please check that you live within our Practice Catchment Area.

If you do not live within our practice catchment area, please do not register with this practice: Practice Catchment Area.

Patient’s Details

Title
Please use this date format: DD/MM/YYYY.
What is your sex as recorded on your NHS record?
Is your gender identity the same as the sex you were assigned at birth? *
We are asking for this information to match your GP record.
Do you consent to receiving text messages from the practice?
This may include general practice information i.e. flu clinic dates, health promotion etc.
Do you consent to receiving emails from the practice?
This may include general practice information i.e. Newsletters, health promotion, notice of flu clinics etc.

Previous Details

Have you ever lived somewhere else in the UK?
Please include postcode.
Please include postcode

Emergency Contact/Next of Kin

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

Ethnicity

Please specify the ethnic group you consider you belong to:
Do you need an interpreter for your appointments?

If you are from abroad

Registering for the first time in the UK

Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been a resident in the UK

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Veterans

Have you ever served in the UK Armed Forces or were you ever registered with a Ministry of Defence GP in the UK or overseas?

If you were given a FMED133A form (sometimes called an FMED1 form) when you left the UK Armed forces, you should give this to your GP surgery.

Carers

Do you have a carer?
Are you a carer for someone?
What type of carer are they?
Do you give us permission to discuss your medical record with your carer?
What type of carer are you?

Please check that the person is happy to be contacted in an emergency should you become unwell whilst on surgery premises

Prescriptions

Please enter address, with postcode

You can sometimes collect your prescription items from your GP surgery instead of having to go to a pharmacy. The surgery may discuss this with you.

Do you live more than 1 mile from your nearest pharmacy?
Would you have serious difficulty getting medicines or appliances from your nearest pharmacy?
Are any of these repeat prescriptions?