New Patient Registration Form

NHSFamily doctor services registrationGMS1

Patient's Details

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Mrs

Miss

Surname:

Date of Birth:

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

First Name(s)

NHS Number:

Previous Surnames:

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Male

Female

Town and Country of birth:

Home Address:

Postcode:

Phone Number:

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

Your previous address in UK:

Name of previous doctor while at that address:

Address of previous doctor:

If you are from abroad

Your first UK address where registered with a GP:

If previous resident in UK, date of leaving:

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

Date you first came to live in UK:

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

If you are returning from the armed forces

Address before enlisting:

Service or personnel number:

Enlistment date:

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

If you are registering a child under 5

Child Surveillance:

I wish the child above to be registered with the doctor named overleaf for Child Health Surveillance

If you need your doctor to dispense medicines and appliances

Not all doctors are authorised to dispence medicines

Dispensing:

I live more than 1 mile in a straight line from the nearest chemist

I would have serious difficulty in getting them from a chemist

NHS Organ Donor registration

For more information on organ donation, please visit: www.organdonation.nhs.uk

NHS Blood Donor registration

For more information, please ask for the leaflet on joining the NHS Blood Donor Register

If you would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood, please visit their website on: www.blood.co.uk or call direct on 03001232323

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Online Services

Patient's Details

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

If you are from abroad

If you are returning from the armed forces

If you are registering a child under 5

If you need your doctor to dispense medicines and appliances

NHS Organ Donor registration

NHS Blood Donor registration

New Patients

Meet the Team

Services

Policies

Monday	08:00 – 18:30
Tuesday	08:00 – 18:30
Wednesday	08:00 – 18:30
Thursday	08:00 – 18:30
Friday	08:00 – 18:30
Saturday	Closed
Sunday	Closed

	On the day	Patients can book an appointment on the day from 08:00 by calling 020 8960 5620 or by calling into the practice.
	Commuter Surgeries	Not able to see the doctor outside of working hours? We offer extended hours on Saturday mornings between 09.00 – 11.00 (Appointments only).
	Evening and Weekend Hubs	For information on evening and weekend hubs, select here.
	Telephone Consultations	For help and advice, call us on 020 8960 5620.
	Nurse Appointments	The Practice Nurses can help you with a range of issues from health management to vaccinations.
	Book in Advance	We reserve a few appointments for advance booking. Please phone the practice on 020 8960 5620 for more information.
	Out of Hours	If you have an urgent health problem which cannot wait until the surgery is open please call 111.
	Online Services	Please register at the surgery by bringing some form of ID to collect your username and password then visit this page to book your appointment https://patient.emisaccess.co.uk/account/login?ReturnUrl=%2F

	Online	You can order your repeat prescriptions via our online form.
	In Person	Fill in a prescription request form or underline the items needed on the tear-off side of your prescription and drop it into the surgery.
	Post	If a stamped addressed envelope is supplied your prescription can be returned via Royal Mail. Find our postal address.
	Fax	Fax your prescription request to 020 8964 1964.
	Pharmacy	You may also arrange for a pharmacy of your choice to collect your prescription on your behalf.

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Patient's Details

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

If you are from abroad

If you are returning from the armed forces

If you are registering a child under 5

If you need your doctor to dispense medicines and appliances

NHS Organ Donor registration

NHS Blood Donor registration

New Patients

Meet the Team

Services

Policies