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New Patient Registrations

registrationIf you wish to register with the practice, please come into reception and you will be given the correct forms to complete.

Alternatively, you can download and print the forms below. Please however take care in ensuring you have completed the correct forms for each patient to avoid delay at registration (please see bottom of page for clarification).

Registration forms can only be accepted physically at the surgery, and cannot be electronically submitted. Completed registration forms can be accepted no later than 5pm.

You will be required to provide proof of address for every patient aged 16 and over who wishes to register. This proof of address should be no more than three months old.

We are currently accepting registrations for patients living within Bewbush and Kilnwood Vale.

Registration Forms:

1.ALL PATIENTS - Family Doctor Services Registration (GMS1)

2.PATIENTS AGED 14 AND OVER - Health Questionnaire, Ethnicity Form and Consent


PATIENTS AGED 16 AND OVER (OPTIONAL) - Online Services Registration Form and Information Leaflet

*Online Services registration forms can only be accepted if the patient can provide two forms of ID: One photo e.g. driving licence or passport, and one proof of address no older than three months e.g. utility bill or bank statement.

*Online Services registration forms cannot be accepted on behalf of a patient. The patient themselves must attend with the above mentioned proof of identity for the form to be accepted.

*Since 1st April 2015, we have been able to offer detailed coded records access (DCRA) for patients aged 16 and over via Online Services. Patients who choose to register for Online Services at the time of registration with our practice will only be granted records access once their full medical records have arrived at the surgery. This can take up to an estimated 8 weeks (delays expected in 2016/2017 due to issues with service provision by PCSE).

4.PATIENTS AGED 13 AND UNDER - Ethnicity Form and Consent

PATIENTS AGED 5 AND UNDER - Health Visitor Form

Which registrations forms do I need?

- Aged 16 and over: Documents 1, 2 and (optional) 3.

- Aged 14-15: Documents 1 and 2.

- Aged 6-13: Documents 1 and 4.

- Aged 0-5: Documents 1,  4 and 5.

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