Child New Patient Registration

Patient’s Details

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

Ethnicity

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

1st Parent/Guardian Details

These details will be used as the primary contact details for the child
Please specify:
Please use this date format: DD/MM/YYYY
Any responses we send will go to this email address.
Do we have your consent to contact you by text?
Do we have your consent to contact you by email?
Is this parent/guardian registered with the surgery?

2nd Parent/Guardian Details

Please specify:
Please use this date format: DD/MM/YYYY
Do we have your consent to contact you by text?
Do we have your consent to contact you by email?
Is this parent/guardian registered with the surgery?

Previous Details

Do you have a previous address in the UK?
Have you previously been registered with a GP in the UK?

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.

Supplementary Questions

I am not ordinarily a resident in the UK

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?

Additional Information

Are you a young carer?
Are you an asylum seeker or refugee?
What level of education are you in?