Skip to main content

Child new patient registration

New Patient Registration – Child

Child’s Details

Please use this date format: DD/MM/YYYY.
Sex

Parent or Guardian Details

Any responses we send will go to this email address.
Can we contact you by text?
Can we contact you by email?

Other Details

Please include postcode.
Please specify the ethnic group you consider you belong to:
Religion:
Housing:
Has a family member ever served in the armed forces?

If you are from abroad

Registering with the NHS for the first time in the UK?
Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Supplementary Questions

I am not ordinarily a resident in the UK

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea
Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?

Communication Needs

Do you speak English?
Do you read English?
Do you need an interpreter?
Do you have any communication needs?
Do you have a learning disability?

Carers

Do you have a carer?