New Patient Registration Form (GMS1)

ANY SECTION UNFILLED WILL RESULT IN LATE REGISTRATION OR REGISTRATION MAY BE REJECTED. IF THEY ARE UNABLE TO FILL ONLINE FORM OR SUBMIT MANDATORY INFORMATION THEN THEY HAVE TO ATTEND THE SURGERY IN PERSON FOR REGISTRATION.

Last Updated: 06/12/2024

  • Patient's Details

    Date of Birth
    For example, 15 3 1984
    Sex (optional)

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

  • If you are from abroad

    Have you ever registered with a NHS GP in the UK? (optional)
    If previously resident in UK, date of leaving (optional)
    For example, 15 3 1984
    Date you first came to live in UK (optional)
    For example, 15 3 1984

  • Armed forces

    Have you ever served in HM Armed Forces? (optional)
    Enlistment date (optional)
    For example, 15 3 1984

  • Complete Registration

    If you need your doctor to dispense medicines and appliances
    Signature

  • Options

    I want to opt out of the Individual Health Record and prevent emergency are medical staff being able to access my key medical information. I have received enough information to make an informed decision and I acknowledge that opting out could be detrimental to my healthcare. Further information is available by visiting www.wales.nhs.uk/individualhealthrecord or by calling NHS Direct on 0845 46 47
    I wish to receive correspondence from us in Welsh

  • To be completed by the doctor

    I have accepted this patient for general medical services (optional)
    I have accepted this patient for general medical services on behalf of the doctor named below who is a member of this practice (optional)
    I will dispense medicines/appliances to this patient subject to Health Board Approval (optional)
    I declare to the best of my belief this information is correct (optional)
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