ADULT New Patient Registration Form

New patient registration form for adult patients

Last Updated: 14/10/2021

Patient Details















Please help us to trace your previous medical records by providing the following




If you are from abroad




If you are returning from the Armed Forces




NHS Organ Donor Register

Organ donation in England changed in May 2020 to an opt out system. You still have a choice whether or not you want to become and organ donor. Please visit the Organ Donation website for more information.

NHS Blood Donor Registration

For more information please visit the NHS Blood Donor website.





SUPPLEMENTARY QUESTIONS | PATIENT DECLARATION for all patients who are nor ordinarily resident in the UK.

Anybody in England can register with a GP Practice and receive free medical care from that practice. However, if you are not 'ordinarily resident' in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside of the European Economic Area must also have the status of 'indefinite leave to remain' in the UK. Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges. More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of your GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service you will always be provided with any immediately necessary or urgent treatment regardless of advanced payment. The information you give on this form will be used to assist in identifying your chargeable status and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purpose of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.






NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS AND S1 FORMS

Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK. If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC)/S1, you may be billed for the cost of any treatment received outside the GP practice, including at hospital)).














How will your EHIC/PCR/S1 data be used?

By using your EHIC or PRC for NHS treatment costs, your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purpose of cost recovery. You clinical data will not be shared in the cost recovery process. Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

Complete GMS1 registration





NEW PATIENT HEALTH QUESTIONNAIRE

Information About You








Medical Information















Carers





Women



Will


Smoking





Alcohol




Family History


Next Of Kin


For patients aged 65 and over or those with chronic diseases (e.g. asthma or diabetes)



Contacting You


Patient Access

Patient Access enables you to have full or partial access to your medical records online. You can order repeat prescriptions, make appointments with Doctors, see blood results and vaccination history.


Proof of Address Provided

PLEASE NOTE - YOU WILL NOT BE REGISTERED UNLESS YOU HAVE SUBMITTED PROOF OF YOUR ADDRESS VIA EMAIL (reception.smg@nhs.net) OR BY ATTENDING SURGERY.


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