College Green Medical Practice
New Patient Registration Form - Adult
Background details
(Stage 1 of 15)
Has the patient been registered with the NHS before?
Yes
No
NHS Number
NHS Number
Find NHS Number of the Patient
If no, enter the date patient entered UK
Full Name
Gender
Select a gender of the patient
Male (including trans man)
Female (including trans woman)
Non-binary
Other (not listed)
Not Stated
Date of Birth (For example, 31 3 1980)
Contact Number (Mobile)
Contact Number (Telephone) (Optional)
Email Address
Address (If you're homeless, you can provide a temporary address, such as a friend's address, a day centre or the GP surgery address)
Previous Address (Optional)
Family registered with us?
Yes
No
Next
Save & continue later