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New patient registration

New Patient Registration
Required fields are labelled

Patient’s Details

Title Required
Please use this date format: DD/MM/YYYY.
Sex Required
Any responses we send will go to this email address.
Can we contact you by text? Required
Can we contact you by email? Required

Ethnicity

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

Religion:
Marital Status:

Emergency Contact

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

Allergies

Do you have any allergies? Required

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.

Supplementary Questions

I am not ordinarily a resident in the UK

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?

Carers

Do you have a carer? Required

Online Services

Would you like online access for appointment booking, viewing results and ordering repeat medications? Required

If you are requesting proxy access, please check the following:

  • Ages 0-10 Parent may request access for online services on behalf of the child – ID required
  • Ages 11 to 15, the child must consent for parents to have online access for them – ID required
  • Ages 16 and over must consent themselves and provide their own ID.

Nominate a Pharmacy

Please nominate a pharmacy for electronic prescribing. This is where you will collect any medications prescribed for you by the doctor.

Summary Care Record

The NHS are changing the way your health information is stored and managed. To provide safe health care if you wish, your medical record containing allergies, medications and diagnostics results can electronically be available to acute hospitals in this country.

Are you happy for us to share your records with the hospital via Summary Care Record and Your Care Connected? Required

Patient Participation Group

The practice is committed to improving the services we provide to our patients. We listen to our patients views via a patient participation group. This group represents the concerns and needs of the patients.

The practice needs patients who are happy to talk about their experiences, views, and ideas for making services better. By expressing your interest, you will be helping us to plan ways of involving patients that suit you.

If you are interested in getting involved, please let us know and we will contact you with more information.

Would you be interested in joining the Patient Participation Group?