New Patient Registration Form (GMS1) and Health Questionnaire

ANY SECTION UNFILLED WILL RESULT IN LATE REGISTRATION OR YOUR REGISTRATION MAY BE REJECTED. IF YOU ARE UNABLE TO COMPLETE THIS FORM OR SUBMIT MANDATORY INFORMATION FOR ANY PERSON THEN YOU SHOULD ATTEND THE SURGERY IN PERSON FOR REGISTRATION.

Last Updated: 28/08/2024

Patient's Details














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




If you are from abroad




Were you ever registered with an Armed Forces GP

These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.






If you need your Doctor to dispense medicines and appliances*

*Not all doctors are authorised to dispense medicines


What is your ethnic group?

Please tick one box that best describes your ethnic group or background from the options below. Please ensure this section is completed as this will result in your application being rejected. 







SUPPLEMENTARY QUESTIONS | 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.







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).














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.

Next of Kin Details






Information About You









Social Details - Please complete for Patients aged 12 and over only:

THIS SECTION MUST BE COMPLETED FOR ALL PATIENTS 12 AND OVER. NON COMPLETION WILL RESULT IN A DELAY TO YOUR REGISTRATION.









Family History - Please complete for Patients aged 12 and over only:

THIS SECTION MUST BE COMPLETED FOR ALL PATIENTS 12 AND OVER. NON COMPLETION WILL RESULT IN A DELAY TO YOUR REGISTRATION.

Please let us know if you have any Family History of the following conditions:
















Consent for Immunisations - Please complete for patients under 16 only

THIS SECTION MUST BE COMPLETED FOR ALL PATIENTS 16 AND UNDER. NON COMPLETION WILL RESULT IN A DELAY TO YOUR REGISTRATION.

IF YOU HAVE MOVED TO THE UK FROM OVERSEAS, PLEASE TICK THE BOX BELOW SO WE CAN CONTACT YOU TO PROVIDE ANY IMMUNISATION HISTORY YOU HAVE FOR YOUR CHILD. 




Contacting You



Complete Registration

Please note, your printed name will be taken as your signature. We will use this as your consent, and confirmation that the above questions have been answered to the best of your knowledge.




To be completed by the GP Practice



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