New Patient Registration Application to Register with a General Medical Practitioner Please note: Your details will be held at the surgery for a limited period of time. You are required to present in person to confirm your registration form, and provide proof of your identity and address Completing this form does NOT guarantee or even imply that you will be accepted onto the practice register Preliminary Questions Please answer these preliminary questions to allow us to structure the the form to only present questions relevant to you. Is this your first registration with a GP Practice in the UK? * Yes No Are you from abroad? * Yes No Are you ordinarily resident in the UK? * Yes No Are you registering a child under 5? Yes No Are you returning from the British armed forces? Yes No Have you ever been in the employ of the British Armed Forces? Yes No Are you a dependent of a current serving member of the British Armed Forces? Yes No Do you need your doctor to dispense medicines and appliances? Yes No Do you hold a non-UK European Health Insurance Card (EHIC), Provisional Replacement Certificate (PRC) or S1 Form? Yes No Next
