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New patient registration

New Patient Registration
Required fields are labelled

Patient’s Details

Title Required
Please use this date format: DD/MM/YYYY.
Gender Required
Any responses we send will go to this email address.
Can we contact you by text? Required
Can we contact you by email? Required

Ethnicity

Please specify the ethnic group you consider you belong to: Required
Do you speak English?
Do you read English?

Emergency Contact

Please use this date format: DD/MM/YYYY.
Are they your Next of Kin? Required
Do you give us permission to discuss your medical records with them? Required

Allergies

Do you have any allergies? Required

Previous Details

Have you previously moved house in the UK? Required
Have you previously been registered at this practice before? Required

If you are from abroad

Registering for the first time in the UK

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

If you are returning from abroad

Previously been a resident in the UK

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

Are you a Military Veteran?

If you have served in the UK Armed Forces, please indicate which service. (For Reservists/Territorial Army please confirm if you have served as a regular service personnel for more than one day e.g. deployed on operations (OP HERRICK etc.), please indicate which service deployed with.

Carers

Do you have a carer?
Are you a carer for someone?