This form is for Care Home staff to register new patients. Please use this form for all new residents including people already registered with the the Practice.
Please note that fields marked "REQUIRED" are compulsory and necessary to complete the registration.
Please continue to send additional information such as patient summaries, medication requests and hospital discharge letters for new residents.
Last Updated: 24/11/2022
Your Details
Please complete this section. Correct information will help us register you promptly and correctly.
NHS Records
Please help us trace your previous medical records by providing the following
If you are from abroad
If you are returning from the armed forces
Registration Signatures
NHS Organ Donor Registration
NHS Blood Donor Registration
PATIENT DECLARATION for all patients who are not ordinarily resident in the UK
NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS
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. 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).
Supplementary questions
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.
How will your EHIC/PRC/S1 data be used?
Essential Information and Care Home status
EPS- the electronic prescription service
EPS is a reliable, secure and confidential service. Your prescription can be sent electronically to a nominated pharmacy of your choice.
Health and Welfare Questions