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

Registering for the first time in the UK

If you are a student from overseas you will need to come into the surgery to register. Please ensure you bring your BRP if you are from outside Europe or your student card if you are from within Europe.

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.

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?