2023 New Patient Registration Form (GMS1)

**PLEASE NOTE WE CAN ONLY ACCEPT REGISTRATION REQUESTS FOR THOSE WHO ARE NEW TO THE AREA AND DO NOT HAVE AN EXISTING GP PRACTICE**

Any section left incomplete may result in your registration being delayed or refused. By proceeding, you are agreeing to us storing your personal data. The form will take about 15 minutes to complete.

You will be notified by text message or email when your registration has been processed. Please note, we require proof of address before we can begin processing your registration. This can take up to 14 days.

Last Updated: 21/03/2024

Patient's Details

Is this your first registration with a GP Practice in the UK? *

Yes No

Sex *

Male

Female

Prefer not to say

Title *

Surname *

Previous Surname (if married/divorced/deed poll)

First name(s) *

Calling name (if you go by your middle name, for example)

Marital status? *

Date of Birth *

Address *

Postcode *

Telephone/Mobile Number *

E-mail address *

Birth Town *

Birth Country *

Community Health Index (CHI) Number

I am a student at University or college *

Yes No

If you answered "yes" to being a student, please tell us where you are studying and your course title

If you answered "yes" to being a student, please tell us the date your course finishes

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

If this is your first registration in the UK, please put N/A in the boxes provided

Your previous address in UK with postcode *

Name of previous GP Practice while at previous address *

Address of previous GP Practice with postcode *

If you are from abroad

This section is mandatory for those who are new to the UK and this is your first registration with a GP Practice. Failure to complete this section will result in a delay in your registration.

Date you first came to live in UK (MANDATORY IF THIS IS YOUR FIRST UK REGISTRATION)

Your most recent country of residence

Do you require an interpreter?

Yes No

If you answered "yes" to question 4, please state the language you speak

If previously resident in UK, date of leaving

If you are returning from the armed forces

You will be contacted by the Practice to obtain further information in order for us to obtain your previous medical records from your military medical centre.

Enlistment date

Leaving date

Service/Personnel No.

Home address before enlisting

Are you a military veteran?

Yes No

Patient Health Questionnaire

Female Patients only

This section will ask you about your female health including smears, contraception, pregnancy and miscarriages.

Are you currently on any contraception?

Yes No

If "yes", please provide details below of what you are currently on. (If you have a coil or implant, please provide date of when this was fitted)

Have you had a cervical smear before?

Yes No

If yes, please provide the approximate date and result

Have you had HPV (human papillomavirus) vaccines?

Yes No

If "yes", please provide the dates of these

If you have been pregnant in the past, how many children do you have?

Have you suffered from any of the following;

Still birth

Miscarriage

Consent

Please let us know whether you consent to receiving appointment reminders by text and communication from the Practice by text and/or email.

Text message *

Yes No

E-mail *

Yes No

PATIENT DECLARATION

I declare that the information I have provided on this form is accurate and complete to the best of my knowledge. I understand that if any areas are incomplete, my registration may be delayed or refused.

I understand that in order to complete my registration request, I should submit proof of my address within 14 days to prevent any further delays.

Please email a photo or scanned copy of your proof of address alongside your full name and DOB to; gram.albynregistrations@nhs.scot

Proof of address should be dated within the last 3 months and can consist of; UK drivers license, utility bill, bank statement, rental/purchase agreement, etc

I have read the declaration above and agree to the terms *

Yes

Are you a parent or guardian, filling out this form on behalf of a child under 16?

Name of parent or guardian

Relationship to patient:

Signed *

Date *

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2023 New Patient Registration Form (GMS1)

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