Tel: 01274 410666

NHS [logo]

Application to Register with a General Medical Practitioner

About this form

Fields marked with a red asterisk are compulsory.

Please fill out this form. We will confirm the accuracy of the details when you attend your appointment.

By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your information.


Personal information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.


Family doctor services registration GMS1

You can complete and submit the form below or alternatively, you can download and print Form GMS1 from the GOV.UK website and hand in at the practice.

Patient Details

//
This is a 10 digit number. It is on any letter you receive from the NHS. Contact your previous GP if you do not know this.
If registering a child, please provide the parent or guardian's phone number.
If registering a child, please provide the parent or guardian's email address.

Residency

Previous GP Details

Please sign to confirm the information provided for registration.

Donor Information

The questions in this section are optional.