New Patient Registration Form

Who is registering?
Only provide your details if you are registering someone else.
For children under 12 months only
For patients under 18 years
What is your ethnic group? (Choose one section from A to E, then tick one box to best Pakistani Bangladeshi describe your ethnic group or background.)
Do you want important information from your GP record to be available to other health and care professionals?
You do not have to complete this section. But any information you do give will help the GP give you the best care.
Information on eligibility to free care outside the GP practice Anyone can register with a GP practice and receive free medical care from that practice. However, should you be referred for treatment outside the practice or need unplanned care, for example at a hospital, charges may apply if you are a visitor or temporary resident. Some groups of visitors or temporary residents are eligible to receive this care free of charge. Documentation may be required to demonstrate eligibility. Examples of those eligible include: • refugees, asylum seekers, those receiving certain forms of state support • suspected or confirmed victims of modern slavery and human trafficking • temporary residents with a valid visa of over 6 months. You may have paid the immigration health surcharge with your visa application. Note that assisted conception services remain chargeable to this group • visitors from the EEA will need to provide their EHIC (European Health Insurance Card), which covers immediately necessary unplanned treatment, or a S2 form which covers planned treatment. Additionally, some services are free of charge to all visitors, including diagnosis and treatment for infectious diseases and sexually transmitted infections. Immediate necessary care, maternity care and other urgent care that cannot wait until a chargeable visitor’s departure from the UK will not be withheld or delayed due to charges. But non-urgent treatment will not be given until full payment is received. More information can be found in the patient leaflet available from the GP practice.
Giving us this information means that if you need NHS care outside the GP practice and you are entitled to that care without charge, it will be easier for you to demonstrate this entitlement. We’ll use the information to establish your chargeable status in order to recover NHS costs from countries responsible for your healthcare where applicable. This will not impact your entitlement to register with the GP practice or to receive free GP services.
Enter details from your EHIC
How will your EHIC and S1 data be used?
By using your EHIC for NHS treatment costs your EHIC 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 or S1 information will be shared with Business Service Authority for the purpose of recovering your NHS costs from your home country
To view our privacy policy, click here