New Patient Registration

If you would like to register with the practice please use this form.

To register a new patient you will need to live within our practice boundary.

If any of the questions in this form do not apply to you, please state ‘N/A’.

Please add 2 forms of ID with your registration, this can be either a passport, driving licence or a Residency Permit and a current utility bill or correspondence that provides your current address.

For children’s registrations, please add either a copy of the birth certificate, a photo of the front page of the red book or a copy of a letter if in receipt of benefits for the child.

New Patient Registration

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Which of the following best describes how you think of yourself? *
Is your gender identity the same as the sex you were assigned at birth? *
We are asking for this information to match your GP record.
Any responses we send will go to this email address.

Please note that your email address will be saved as part of your contact details in your medical records. We may contact you via your email address if you become locked out of your online account and need your password sent, or to send you health questionnaires.

In future we may send you clinical letters via email instead of as a posted letter for speed and to reduce our carbon footprint. You can opt-out of this by telling the Practice.

Can we contact you by text? *
Can we contact you by email? *


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

Emergency Contact

Are they your next of kin? *
Do you give us permission to discuss your medical records with them? *


Do you have any allergies? *

Previous Details

Do you have a previous address in the UK? *
Please include postcode.
Do you have a previous GP in the UK? *

If you are from abroad

Registering with the NHS for the first time in the UK
Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Supplementary Questions

I am not ordinarily a resident in the UK

Ordinarily Resident

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. Alternatively for more information go to

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

Please select one of the following statements:

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate
action may be taken against me.

A parent/guardian should complete the form on behalf of a child under 16.

European Economic Area (EEA) Country

For a list of EEA countries visit:
Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?
Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) ?

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.


Please enter the details from your EHIC or PRC below.

S1 Form

Do you have an S1 Form?
Please give your S1 form to the practice staff.

How will your EHIC/PRC/S1 data be used?

By using your EHIC or PRC for NHS treatment costs your EHIC or PRC 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, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

Sharing Your Health Care Records and Information

Your patient record will be held securely and confidentially on our electronic system. If you require treatment in another NHS healthcare setting such as an Emergency Department or Minor Injury Unit, those treating you would be better able to give you appropriate care if some of the information from the GP practice were available to them.

This information is your summary care record.

Please view the Summary Care Record page so you can make informed decisions on the next section.

NHS Summary Care Record

Your choice for Summary Care Record: *

Your choice for Gloucestershire shared health and social care information (JUYI/EMIS Shared) (Used locally across Gloucestershire)

Gloucestershire shared health and social care information (JUYI); *

Enhanced Data Sharing Model (SystmOne clinical system)

Enhanced Data Sharing Model (SystmOne clinical system) - Sharing Out *
Enhanced Data Sharing Model (SystmOne clinical system) - Sharing In *
If the person signing is not the patient, please give name and relationship to the patient.


Do you have a carer? *
Are you a carer for someone? *
Do you give us permission to discuss your medical record with your carer? *