New Patient Registration

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

If you are registering a Child please use our Child Registration form.

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

When registering please bring with you photographic ID (e.g. Passport, Drivers Licence etc.). You will also need to confirm your current address (e.g. a utility bill, current bank statement, etc.). If you are registering a child under the age of 16 please bring the child’s Birth Certificate, Passport or Red Book.

After filling in this form you will need to bring your ID to the practice to complete your registration, this needs to be done within 28 days. If you have not brought your ID into the Practice after 28 days have passed we will assume you no longer wish to register as a patient and your pending registration form will be removed from our records.

Please note that your medical records may take some time to be transferred from your previous practice, should you need regular medication it will help if you bring your medication in with you when you see a Doctor.

New Patient Registration (Adult)

New Patient Registration (Adult)

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Gender *
Any responses we send will go to this email address.
Can we contact you by text?
Can we contact you by email?
Are you able to administer your own medicines?
Your Religion


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

Emergency Contact

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

Previous Details

Please include postcode.


Do you have any allergies?

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.

HM Armed Forces Veteran

Have you ever done Military Service?
Please use this date format: DD/MM/YYYY.

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 have a carer?
Are you a carer for someone?
Are you foster carer?
Do you give us permission to discuss your medical record with your carer?
Do you have a living will (a statement explaining what medical treatment you would not want in the future)? *
Can you please bring a copy of it into the Surgery for scanning onto your patient record.
Have you nominated someone to speak on your behalf (e.g. a person who has Power of Attorney)? *