Muswell Hill Practice New Patient Registration Form (GMS1) + New Baby Information

Fields marked REQUIRED are compulsory. You should only send this form if you are sure that you are eligible to join this practice. Sending this form will NOT automatically register you with the surgery. Your details will be held at the surgery for a limited period of time. You are required to present in person to sign your registration form and provide proof of your address. Sending this form does NOT guarantee or even imply that you will be accepted onto the practice register. Please input details of the baby being registered, and complete an adult registration form for each parent registering.

Last Updated: 15/02/2023

Initial Questions

I am completing this form on behalf of... *

Today's Date

State your relation to them:

Baby's Details

Please help us trace the patients previous medical records by providing the following

NHS number (Your previous doctors surgery can provide you with this) *

Title *

Surname *

First name(s) *

Previous Surname

Date of Birth *

Birth Country *

Birth Town *

Birth Hospital/Borough *

Sex *

Male

Female

Address *

Postcode *

Telephone *

Email Address *

Contact with the Surgery

Important questions to help you use our services - we will use these details to contact you about services for the child you are registering

Do you want to receive text reminders to mobile telephones about appointments and other clinical services? *

Yes No

If yes, please provide your email address?

Previous GP

Please help us trace the patient's medical records by providing the following information:

The patients previous address in the UK *

Name of previous GP practice while at this address *

Address of previous GP practice *

If you are from abroad

Patient's address where registered with a GP

If previously resident in UK, date of leaving

Date Patient first came to live UK (DD/MM/YYYY) *

Next of Kin

Please provide details of who to contact in case of emergency.

Title *

Name *

Surname *

Contact number *

Relationship to patient *

New Baby Information

Name of Parent 1 *

Name of Parent 2

Ethnicity and languages

Please select the patient's ethnic group *

Complete Registration

Thank you for completing your registration form, please be aware that forms take 1 week to process, after which you can book an appointment. If you are registering as a household, each person must have their own registration form. Registration forms for adults and children under 15 can be found on our registrations page.

Signature on behalf of patient *

I understand that registration forms take 2 week to process, after which I will be able to make an appointment. *

Yes No

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Muswell Hill Practice New Patient Registration Form (GMS1) + New Baby Information

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