New Patient Registration

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

It is important that you first check to confirm you live within our Practice Boundary before you complete this registration form. We currently have a number of developments being built so if you are moving into one of these and think your postcode is within our area, please Contact Reception as it can take a little while for new postcodes to be recognised.

If you are registering a child under 14 years old please complete our Child Registration Form.

In order to complete the registration process, you will need to bring into the Practice photo ID and proof of address. Please be aware that it may take up to 2 weeks for us to complete the registration process so please help us to help you by bringing in your ID as soon as possible.

Please bring in ID and proof of address after 2pm as mornings are our busiest time of the day.

Temporary Patients

If you are staying temporarily within our boundary area and need to see a GP or nurse, please contact reception to discuss your needs and they will tell you what you need to do to register as a temporary patient. Practice boundaries often cross over, so the general rule is that if you are staying with someone (friend/family/relative) we would normally expect you to be seen by the practice they are registered with. If you are here for work/visiting and staying in a hotel/guest house etc. you can ask to be seen at any GP practice that covers that area. Reception can be contacted on 01344 773 418 8:00am-6:30pm Monday to Friday. If we are closed please call NHS 111 for advice and assistance.

Patient's Details

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Nationality

Next of Kin Details

Emergency Contact

Allergies

Previous Details

Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK
Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Supplementary Questions

Ordinarily Resident

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 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. Alternatively for more information go to www.nhs.uk/visitingengland.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the 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 advance 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 purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

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.

A parent/guardian should complete the form on behalf of a child under 16.

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea

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 of the GP practice, including at a hospital.

EHIC/PRC

Please enter the details from your EHIC or PRC below.

S1 Form

Please give your S1 form to the practice staff.

How will your EHIC/PRC/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 purposes of cost recovery. Your 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.

Carers

Veteran Details