Before new patients can be taken onto our list, registration forms and a patient history form must be completed and you will have to attend the practice for a simple health check.

If this is your first time registering in the UK you should bring with you proof of your eligibility, for example a document bearing your NHS number or, failing that, your passport.

Before any medication can be issued you must have an appointment with our clinical pharmacist. 

New Patient Registration - Adults

Date of Birth Required
Which of the following best describes how you think of yourself?
Is your gender the same as the sex you were assigned at birth? Required
Do you consent to being contacted by SMS on this number

It is your responsibility to keep us updated with any changes to your telephone number, email & postal address. We may contact you with appointment details, test results or health campaigns.



Next of Kin Details



Please help us trace your previous medical records by providing the following information



If you are from abroad

Please add birthdate as entry date if not new to country

Date you first came to live in UK Required


Were you ever registered with an Armed Forces GP

Please indicate if you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas:
Enlistment date
Discharge date: (if applicable)


NHS Organ Donor registration

You will automatically be considered that you agree to become an organ donor when you die unless you are under 18, have opted out or are in an excluded group.

For further information, please see:


NHS Blood Donor registration

Would you like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood.
Have you given blood in the last 3 years


PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

Anybody in England can register with a GP practice and receive free medical care from that practice. However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK. Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges. More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment. The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

Please select one of the following statements Required



Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.

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.

Do you have a non-UK EHIC or PRC? Required
Date of Birth
Expiry Date
Do you have an S1 (e.g. you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state).

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.


Registration Details

Ethnicity Required
Religion Required


Communication Needs

Do you need an interpreter? Required
Do you have any communication needs? Required
If Yes please specify your communication needs below
Do you have a Learning Disability? Required

If Yes please request a Learning Disability Screening Tool form


Carer Details

Are you a carer? Required

If yes please provide the details below. Only add carer’s details if they give their consent to have these details stored on your medical record


Medical History

Have you suffered from any of the following conditions?


Family History

Please record any significant family history of close relatives with medical problems and confirm which relative e.g. mother, father, brother, sister, grandparent




Current Medication

Are you on regular medications? Required



Please answer the following questions which are validated as screening tools for alcohol use

How often do you have a drink containing alcohol? Required
How many units of alcohol do you drink on a typical day when you are drinking? Required
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? Required
How often during the last year have you found that you were not able to stop drinking once you had started? Required
How often during the last year have you failed to do what was normally expected from you because of your drinking? Required
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? Required
How often during the last year have you had a feeling of guilt or remorse after drinking? Required
How often during the last year have you been unable to remember what happened the night before because you had been drinking? Required
Have you or somebody else been injured as a result of your drinking? Required
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? Required



Do you smoke? Required
Do you use an e-Cigarette? Required
How many cigarettes did/do you smoke a day?
Would you like help to quit smoking?


Women Only

Do you use any contraception?
Do you have a coil or implant in situ?
Are you currently pregnant or think you may be?


Students Only

Students are at risk of certain infections including mumps, meningitis and sexually transmitted infections, as well as mental health issues including stress, anxiety and depression. Please see

I am less than 24 years old and have had two doses of the MMR Vaccination


Further Details

Electronic Prescribing

Patient Participation Group

We are committed to improving the services we provide. The Patient Participation Group is a mechanism for us to gain valuable feedback from our patients about their experiences, views and ideas for improving our services.

Would you like to be involved in our Patient Participation Group?


Sharing Your Health Record

Do you consent to your GP Practice sharing your health record with other organisations who care for you?
Do you consent to your GP Practice viewing your health record from other organisations that care for you?


Your Summary Care Record (SCR)

Do you consent to having an Enhanced Summary Care Record with Additional Information?


Online Access To Your Health Record

I wish to have online access to: (Please select all that apply)
I wish to access my medical record & understand & agree with each statement: Required

The practice will be in contact to collect ID and registrations can take up for 5 working days from receipt of ID, and the registration will not be processed without ID unless prior approval has been granted

I am aware that the registration won’t be accepted until identification is provided to the practice