New Patient Registration - Children

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 be seen by one of the doctors or nurse practitioners.

Please ensure you have read the information in these downloads below completing the online registration form below:

Your Child's Details

Which of the following best describes how you think of yourself?
Is your gender the same as the sex you were assigned at birth?


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



If you are from abroad


These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.


If you need your doctor to dispense medicines and appliances*

* Not all doctors are authorised to dispense medicines

Do you live more than 1.6km in a straight line from the nearest chemist
Would you have serious difficulty in getting them from a chemist


NHS Organ Donor registration

Please tell your family you want to be an organ donor. If you do not want to be an organ donor, please visit or call 0300 123 23 23 to register your decision.

I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death. Please select the boxes that apply.


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
I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate action may be taken against me. Required
Are you:



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?

If yes, please enter details from your EHIC or PRC below:

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.


Your Child's Registration Information

Ethnicity Required
Religion Required


Your Child's Communication Needs

Do you need an interpreter? Required
Does your child have any communication difficulties Required
If Yes please specify below Your communication needs
Does your child have a Leaming Disability? Required


Your Child's Medical History

Has your child suffered from Asthma? Required
Has your child suffered from Diabetes? Required
Has your child suffered from Depression? Required
Has your child suffered from Epilepsy? Required


Your Child's 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

Asthma Required
COPD Required
Epilepsy Required
Heart Disease Required
Stroke Required
Blood Pressure Required
Diabetes Required
Kidney Disease Required
Liver Disease Required
Depression Required
Thyroid Required
Cancer Required


Your Child's Allergies



Your Child's Current Medication

Are they on regular medications? Required


Electronic Prescribing


Sharing Your Health Record

Please ensure you read the "Sharing Your Health Record" download at the top of this page

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


Your Summary Care Record (SCR)

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


Online Access To Your Health Record

Please ensure you read the "Access to GP Online Services" download at the top of this page

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

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 Required


Parent or Guardian Details

Do you consent to being contacted by SMS on this number
Do you consent to being contacted by email at this address

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

If you are registering for the first time at a practice in England to complete your registration please provide your childs Immunisation Information either in person at the practice or by email