New Patient Registration

Welcome to our Practice, we hope your stay will be a happy and healthy one. As it may take some time for your medical record to come from your previous Doctor it would be helpful if you would complete this form and return it to us.

Once you have completed this form you will also need to complete the New Patient Questionnaire, which follows on from your first submission.

If you would like to see a doctor or nurse to discuss an ongoing medical condition please make an appointment.

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



Patient's details

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Previous medical records

Have you previously been registered at another practice?

If you are from abroad

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Armed Forces

Were you ever registered with an Armed Forces GP?
Which one best applies to you?
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Footnote: 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 charity services.

Dispensed medicines and appliances

If you need your doctor to dispense medicines and appliances
Not all doctors are authorised to dispense medicines

NHS Organ Donor registration

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 tick the boxes that apply:

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.

NHS Blood Donor registration

I would 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?:

All blood types are needed, especially O negative and B negative. Visit or call 0300 123 23 23.

To be completed by the GP Practice

Supplementary Questions

These questions and the patient declaration are optional and your answers will not affect your entitlement to register or receive services from your GP.

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 boxes:
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.

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.

Non-UK European health insuance card (EHIC), provisional replacement certificate (PRC) details and S1 forms.
Do you have a non-UK EHIC or PRC?
Please enter details from your EHIC or PRC below:
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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.
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.