Family Doctor Services Registration GMS1

Please complete the below GMS1 registration form to pre-register at the practice.

PLEASE NOTE: The information you submit does not mean we will automatically register you at the practice.  You will still need to visit the practice to complete the registration process, show your ID and sign the relevant forms to confirm the details are correct.  

When you register you will also be asked to fill out a medical questionnaire.  This is because it can take a considerable amount of time for us to receive your medical records.  There is an online version of this form too which you can complete and send to us.  Again, when you visit the surgery you will be asked to sign this form to confirm that the details are correct.

Patient's details

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

Previous medical record
If you are from abroad
If you are returning from the armed forces
If you are registering a child under 5
If you need your doctor to dispense medicines and appliances
Signatures
NHS Organ Donor Registration

I want to register my details on the NHS Organ Donor Register as someone who's organs/tissue may be used for transplantation after my death.

For more information, please ask at reception for an information leaflet or visit the website www.uktransplant.org.uk, or call 0300 123 23 23.

NHS Blood Donor Registration

I would like to join the NHS Bood Donor Register as someone who may be contacted and would be prepared to donate blood.

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

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.

Please tick one of the following boxes: *

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.

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 of the GP practice, including at a hospital.

European Health Insurance Card
European Health Insurance Card

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.