New Patient Registration

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

Alternatively you can register using the online GP Registration Service.

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

Registration will take up to 3 working days to process and complete.

New Patient Registration

New Patient Registration

In order to get the best care when you join our surgery, we ask that you fully complete all forms for each new patient. If you have any problems filling in the forms, please ask a receptionist for help. If you would like a new patient check with a healthcare professional, please ask the receptionist for an appointment. Please bring a specimen of urine to this appointment.

Patient's Details

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 text?
Can we contact you by email?
Preferred Contact Method
Do you consent to the receipt of text messages and emails in relation to your medical care, i.e. appointment reminders, test results, information regarding flu clinics or other clinic relevant to your medical care? *
Would you like to receive additional information relating to other services that you may find beneficial to your health and wellbeing? *
Do you wish to register for online services? *
This allows you to order repeat prescriptions and book appointments online.

Nationality / Ethnicity

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


Sexual Orientation

What is your sexual orientation?

Other Contacts

Please tell us about any other people that you want to be involved in your care. Or for children information regarding who is mother and father and their contact details. It is also helpful for us to know who we can discuss your health with if at any stage you are unable to make decisions for yourself - we will not discuss your situation with other people without your consent unless we had no other option. If you want a family member or friend to be involved with your care, please give their names below.

Do you consent to us discussing your care with this person?
Is this person happy for us to contact them in an emergency situation?
Do you consent to us discussing your care with this person?
Is this person happy for us to contact them in an emergency situation?

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.

Armed Forces

Are you a veteran of the armed forces?

Supplementary Questions

I am not ordinarily a resident in the UK

Ordinarily Resident

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. Alternatively for more information go to

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:

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.

A parent/guardian should complete the form on behalf of a child under 16.

European Economic Area (EEA) Country

For a list of EEA countries visit:
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.


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.


Do you need / have anyone who looks after you or your daily needs as a carer?
Are you a carer for someone else who is ill, frail, disabled or mentally ill?
Do you give us permission to discuss your medical record with your carer?

If you are a carer

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

Details of the person you look after

Please use this date format: DD/MM/YYYY.
I consent to my details being added to the Carers Register held at the practice.