New Patient Registration

If you haven’t already, sign up using our new online registration form today in less than five minutes! 

See below how to complete a family doctor services registration (GMS1) form.

Main Details:

Title – Mr Mrs Miss Ms – Tick the appropriate box

 

Surname – Please make sure the spelling given is the same that appears on your passport, driving licence or Home Office paper work.

 

Date Of Birth – Please enter the Day, Month and Year within the boxes given.

 

First Names – Please make sure the spelling is the same that appears on your documents.

 

Previous Surname/s – If you are married please state your maiden name or any other surname/family name you have been known by.

 

NHS Number – Your NHS Number can be found on your medical card or your last doctors surgery can provide this. NB,  it is not your National Insurance Number.

Male / Female – Please tick appropriate box.

 

Town and Country of Birth – Please enter this information if you were born in this country, for example, Hammersmith, Hounslow, Maidstone-Kent.  If you were born abroad please state the country and town for example, Bombay-India.

 

Home Address – If you are living in a flat please state clearly the Flat number, building name and the road number and name.

 

Post Code – Your address is incomplete without a postcode.

 

Telephone Number – Please enter Home, Mobile or Work phone numbers if available.

 

Your Previous Address in UK – If you were previously registered with a GP Practice then please write the address you were living at when registered. If you have left the country and are now returning again please write the address when you were last registered with a GP Practice within the UK. If you have never, to your knowledge, been registered with a GP Practice then just state your previous address where you were living.

 

Name of previous Doctor while at that address – Please state the Doctor’s name within the GP Practice where you were registered.

 

Address of previous Doctor – Please state the address of your previous surgery.  If you don’t know, please be as precise as possible as to the area, for example Hounslow-Heath or Slough-Berkshire.  If just arriving into the country and you are unsure if you have been registered with a GP Practice, still state the area where you may have visited a GP Practice.

 

If you are from abroad:

Your first UK address where registered with a GP – If this is your first visit to the UK please state the address you first stayed at. If you are returning back to the UK please state the address where you were last registered with a GP Practice within the UK, even if that address was the address you were living in before you left the UK.

If previously resident in UK, Date of leaving – Please state the date you left the UK.

 

Date you first came to live in UK – If you have arrived in the UK for the first time please state the date you arrived. If you are returning back to the UK, please state the date you arrived but remember to also fill in the date you left.

 

If you are returning from the Armed Forces:

Address before enlisting – Please state the address where you were last registered with a GP practice before enlisting.

Service or Personnel number – This can be found on your Discharge Papers.

Enlistment Date – This can be found on your Discharge Papers.

Remember to sign the bottom of the form and date it and then turn over.

 

If you want to be added to the NHS Organ Donor Register, please complete this section, again remember to sign and date your consent. Do the same if you want to be added to the NHS Blood Donor Register.

 

It is very important that this form is filled in accurately or this may mean a delay in receiving your medical records. Therefore if you have any queries or questions it is best to ask the Surgery staff.

Click here to access our new online form!