New Patient Registration – Adult 16+

Patient’s Details

Title *
Please use this date format: DD/MM/YYYY.
If known.
Gender Assigned at Birth: *
Do you currently identify as your birth gender?
How long will you be at this address?
Are you in a stable housing situation?

Examples of Yes: renting in your own name, living with parents/family, shared student house/hall, own home.

Examples of No: staying temporarily with friends/ family, emergency/temporary housing, homeless.

Are you currently a student or member of staff at a University (full-time or part-time)?
I am:
Name of University:
Please use date format DD/MM/YYYY
Are you an overseas student?
Any responses we send will go to this email address.
Can we contact you by text?
Can we contact you by email?

Care Home Status

Are you a care home resident?
Which type?

If you are from abroad

Please use this date format: DD/MM/YYYY.
Why did you come to the UK?

Previous Details

Have you ever been registered with a GP in the UK?
Please include postcode.

Your Next of Kin / Emergency Contact

Communication Needs

Do you have any special communication needs?

Please let us know what you need below.

About You

Please specify the ethnic group you consider you belong to:
Do you have any problems speaking English?
Do you have any problems reading English?
Do you need an interpreter when you visit the doctor?
Please select which best describes your sexual orientation:
Marital status:
Are you a main carer (unpaid) for someone who has poor health or diasbility?
Are you a military veteran or reservist from the British Armed Forces?

Health and Lifestyle

Do you take regular medication?

Your prescriptions will be sent electronically to this pharmacy. You can change your pharmacy at any time.

Do you have any long-term illness, health problem or disability?
Do you have a carer (paid or unpaid) due to poor health or disability?
Smoking Status:
Are you interested in advice on how to quit?

Alcohol Consumption

This is one unit of alcohol:

Amount of different types of drink representing one unit of alcohol

And each one of these, is more than one unit:

Amount of different types of drink representing more than one unit of alcoholAmount of different types of drink representing more than one unit of alcohol
How often do you have a drink containing alcohol? *
How many units of alcohol do you drink on a typical day when you are drinking? *
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? *

Access to GP Health Records

From the 4th October 2023 all patients will automatically be able to view their prospective GP records using the NHS App. The NHS App, website and other online services are all very secure, so no one is able to access your information except you. You’ll need to make sure you protect your login details. Don’t share your password with anyone as they will then have access to your personal information.

More information on access to your GP health records is available by visiting: GP health record – NHS App help and support

If you do not want to see your health record using the NHS App please tick this box:

If you would like more information about these changes please speak to your GP or the reception team.

To help complete your registration, please upload proof of identity, this should include photographic ID and proof of address.
Maximum upload size: 67.11MB