New Patient Registration – Adult 16+

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

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

New Patient Registration – Adult 16+

Patient's Details

Title
Please use this date format: DD/MM/YYYY.
Gender: *
If known.
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 full time or part-time University student?
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?

If you are from abroad

Registering with the NHS for the first time in the UK
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:
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? *
To help complete your registration, please upload proof of identity, this should include photographic ID and proof of address.
Maximum upload size: 67.11MB