2023 New Patient Registration Form (GMS1)

ANY SECTION UNFILLED WILL RESULT IN LATE REGISTRATION OR REGISTRATION MAY BE REJECTED. IF THEY ARE UNABLE TO FILL ONLINE FORM OR SUBMIT MANDATORY INFORMATION THEN THEY HAVE TO ATTEND THE SURGERY IN PERSON FOR REGISTRATION.

Last Updated: 29/03/2023

  • Patient's Details

    Date of Birth
    For example, 15 3 1984
    Sex (optional)

  • Please help us trace your previous medical records by providing the following

  • If you are from abroad

    If previously resident in UK, date of leaving (optional)
    For example, 15 3 1984
    Date you first came to live in UK (optional)
    For example, 15 3 1984

  • If you are returning from the armed forces

    Enlistment date (optional)
    For example, 15 3 1984

  • Complete Registration

    If you are registering a child under 5 (optional)
    If you need your doctor to dispense medicines and appliances
    Signature

  • NHS Organ Donor Registration

    For more information, please ask for the leaflet on joining the NHS Organ Donor Register

    Do you want to register your details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after your death?
    Please tick the boxes that apply:

  • NHS Blood Donor Registration

    For more information, please ask for the leaflet on joining the NHS Blood Donor Register

    Would you like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood?
    Have you given blood in the last 3 years?

  • PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

    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. 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 tick one of the following boxes: (optional)
    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.

  • NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS

    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 the GP practice, including at hospital).

    Do you have a non-UK EHIC or PRC? (optional)
    Date of Birth (optional)
    For example, 15 3 1984
    Expiry Date: (optional)
    For example, 15 3 1984
    a) From: (optional)
    For example, 15 3 1984
    b) To: (optional)
    For example, 15 3 1984
    Please tick if you have an S1 (e.g. you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state). Please give your S1 form to the practice staff. (optional)

  • Supplementary questions

  • Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.

  • 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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.