We will from time to time have to contact patients via SMS text message. this is extremely helpful particularly in the current state of pandemic.
Previous Medical Records
Please help us trace your previous medical records by providing the following information.
Dispensing Of Medicines And Appliances
Organ & Blood Donation
NHS Organ Donor Registration
I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death.
NHS Blood Donor registration
I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood.
For all patients who are not 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 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.
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.
(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.)
Non-UK European Health Insurance Card (EHIC), Provisional Replacement Certificate (PRC) Details
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
Please enter details from your EHIC or PRC below:
PRC Validity Period
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.
Proof of Identity and Address Provided
We require proof of identity and address - please email a copy of your identity as well as proof of address to firstname.lastname@example.org with "New registration ID" as the subject header. If you do not provide us with proof of ID and address we may be unable to proceed with your registration.
Proof of Address, Proof of Identity etc
Max. file size: 50 MB, Max. files: 10.
Drop files here or
Next of Kin Information
Please provide us with information of your Next of Kin - Somebody we can contact in a state of emergency.
Online access to your medical records
We are offering patients access to their online records. You can view test results, history and request repeat medication without hassle.
Please state your relationship to the individual and in the case of cancer, the type of cancer.
Please complete this section as accurately as possible.
If none, please state "None"
Patient Participation Group
We would like to invite you to join our Patient Participation Group! Do you want to improve health and health services in your local community? Do you want to have the opportunity to have a voice and get involved in the way your health service is run? Do you want to help shape and improve services and even get involved in shaping and delivering new and exciting services?
Please note - if there are any queries we will contact you in order to obtain more information. your registration may not be processed until this information is obtained. Also, you may not be able to see a GP until you have had a new patient health check with our nursing team.