Adult New Patient Registration

If you are over the age of 18 and have been allocated to us to register as a new patient, please use this form. You cannot fill out this form if you have not been allocated to the surgery.

Please make sure you live within our Practice Boundary.

Please complete a separate form for each family member to be registered.

One you have completed this form, you will need to come into the surgery with the following:

  • A form of photographic ID i.e. a passport or driving license
  • A utility bill from the last three months with your current name and address on
  • A copy of your repeat prescription if you are on regular medication
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?


What is your ethnic group? *
Which one best describes your White background? *
Which one best describes your Mixed background? *
Which one best describes your Asian or Asian British background? *
Which one best describes your Black or Black British background? *
Which best describes your other ethnic group background? *
Do you speak English?
Do you read English?
Your main or 1st language spoken/understood:


What is your religion?

Next of Kin

Do you give us permission to discuss your medical records with them?

Previous Details

Please help us trace your previous medical records by providing the following information
Please include postcode.
Has your previous medical data been released?

If you are from abroad

Registering with the NHS for the first time in the UK
Please include postcode.
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

Were you ever registered with an Armed Forces GP

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
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:
Please include postcode.
Please use this date format: DD/MM/YYYY
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?
Do you wish us to disclose information about your health to your Carer?
Are you a carer for someone?
Are you or have you ever been under Social Care?