New patient registration (adult 16+)

Patient’s details

Title: *
Please use this date format: DD/MM/YYYY
Sex: *
Your NHS number is a 10 digit number that you find on any letter the NHS has sent you. For example, 485 777 3456.
Any responses we send will go to this email address
Can we contact you by text?
Can we contact you by email?

Emergency contact

Are they your next of kin?
Do you give us permission to discuss your medical records with them?

Previous details

Please include postcode.

If you are from abroad and registering with the NHS for the first time

Please use this date format: DD/MM/YYYY

If you are returning from abroad and have previously been registered with the NHS

Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY

Were you ever registered with an Armed Forces GP

Please indicate if you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas:

Ethnicity

What is your ethnic group?

Supplementary questions

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. You can also find more information about visiting or moving to England on the NHS website.

Are you ordinarily resident in the UK?

Not ordinarily resident

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. A valid exemption includes for example, an EHIC, or payment of the Immigration Health Charge (“the Surcharge”), when accompanied by a valid visa. 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.

You are declaring that the information given on this form is correct and complete. If it is not correct, appropriate action may be taken against you.

A parent/guardian should complete this section on behalf of a child under 16.

Do you understand your chargeable status? *

European Economic Area (EEA) country

Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?
Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) ?

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

Do you have an 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.