Fields marked "REQUIRED" are compulsory. You should only send this form if you are eligible to join the practice, which means your home address is within the practice boundary. Sending this form will NOT automatically register you with the practice. If you are eligible, we aim to process this form within 10 working days. If you are not eligible to join the practice, we will inform you.
Last Updated: 05/05/2021
1) Patient's Details
2) Please help us trace your previous medical records by providing the following information
3) If you are from abroad (if not applicable go to next question)
4) If you are returning from abroad and you have been previously resident in the UK (if not applicable go to next question)
5) If you are returning from the Armed Forces (if not applicable go to next question)
These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.
6) Additional Registration Questions
7) Female Patients (if not applicable go to next question)
For women aged 25-49 cervical screening is every 3 years and for patients aged 50-65 every 5 years. For further information on cervical screening and smear test please see the following website: https://www.nhs.uk/conditions/cervical-screening
8) Children & Young Adults Aged 0-18 Additional Questions (if not applicable go to next question)
9) Complete Registration
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.