New Patient Registration

We are able to register patients within our Practice Boundary. If you would like to register with the practice please use this form.

Please read our Data Sharing Information page before completing the form.

New Patient Registration

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Gender *
Marital Status:
Please include house name and/or number. If you are a student attending Plymouth University, please enter your University address.
Your preferred choice of contact:
Can we contact you by text?
Can we contact you by email?
Do you consent to the surgery leaving messages on your phone?

We will not leave detailed messages on your phone, but may ask you to contact us or leave a simple mesage if we do not need to speak to you.

Ethnicity

Please specify the ethnic group you consider you belong to: *
Do you speak English? *
Do you read English? *

Emergency Contact

Are they your Next of Kin? *
Do you give us permission to discuss your medical records with them? *

Allergies

Do you have any allergies? *

Previous Details

Please include postcode.

If you are from abroad

Once you have completed your online registration and it has been processed by our team you will receive an email asking you to reply with a photo of your BRP card. This will be deleted from our email account after 21 days.

If you are returning from abroad

Previously been a resident in the UK

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Supplementary Questions

I am not ordinarily a resident in the UK

Ordinarily Resident

Please select one of the following statements:

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

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.

If you are returning from the Armed Forces

DD/MM/YYYY
DD/MM/YYYY

If you are returning from the Armed Forces please complete our HM Forces Patient Form

If you are registering for a child under 5

If you need you doctor to dispense medicines*

 *Not all doctors are authorised to dispense medicines

Mobility

Do you have significant mobility issues
Are you housebound?

(Definition of housebound - A patient is unable to leave their home due to physical or psychological illness)

Carers

Do you have a carer? *
Are you a carer for someone? *
Do you give us permission to discuss your medical record with your carer?