New Patient Registration

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

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

All new patients will be asked to provide proof of address dated within the last 3 months and this can be uploaded when the form.

When registering children under 16 years of age these must be registered at the same address as at least one person with parental responsibility or legal guardianship. As well as proof of address registrations for children will also need to upload a copy of the child’s birth certificate.

Please be advised that this registration process can take up to 2 weeks to fully process. If you are prescribed regular medication you should ensure you have a sufficient supply from your previous practice.

Once registered those over the age of 18 years are eligible for a new patient health check if you wish to book one with our Healthcare Assistant.

Please also view our Practice Charter.

New Patient Registration

New Patient Registration

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Gender *
Any responses we send will go to this email address.
Do you consent to receiving SMS notifications for clinical services? *
Do you consent to receiving email notifications for clinical services? *
Preferred Contact Method:

If you are under 16 years of age, please provide the following information:

Ethnicity

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?
Is this person also a patient at the practice?

Previous Details

Please include postcode. If you do not have a previous address in the UK, please state N/A.
If you do not have a previous GP in the UK, please state N/A.

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.

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 www.nhs.uk/visitingengland.

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: www.gov.uk/eu-eea
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.

EHIC/PRC

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.

For Patients returning from the Armed Forces