New Patient Registration

If you have an NHS Account (that you use to log into the NHS app with) please register at Register with a GP surgery: St. Stephens Gate Medical Practice.

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.

Accessibility Information

We want to know if you need information in braille, large print or easy read. We want to know if you need a British Sign Language interpreter or advocate.

We want to know if we can support you to lipread or use a hearing aid or communication tool.

Please note, this form should be completed if there are children in the family under 5 years old. Once again, please ensure this form is filled in full with as much information as you can remember.

This is important and provides us with information regarding your health conditions and history, medications and general lifestyle information.

Guide to GP Services

The Royal College of General Practitioners has produced a useful guide for patients, about the services on offer at GP Surgeries and how to access them. You can download the guide.

New Patient Registration

Practice Boundary

Do you live inside of our practice boundary? *

As you do not live within our practice boundary, we will not be able to register you as a patient.

If you are away from home and require urgent care, please complete our Temporary Residents Registration form.

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Sex *
Gender identity:
Is your gender identity the same as the gender assigned at birth?
Any responses we send will go to this email address.
Can we contact you by text?
Can we contact you by email?

Ethnicity

Please specify the ethnic group you consider you belong to:
Do you speak English?
Do you read English?
Do you need an interpreter?

Emergency Contact

Are they your next of kin?

Allergies

Do you have any allergies?

Previous Details

Please include postcode.

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.

Armed Forces

Have you previously served in any of the armed services?
Are you content that this is recorded in your medical records?

Supplementary Questions

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 www.nhs.uk/visitingengland.

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: www.gov.uk/eu-eea
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.

EHIC/PRC

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.

Carers

Do you have a carer?
Are you a carer for someone?
Has the person given consent for their details to be shared?
Is the person you care for a patient at this surgery?