Family Doctor Services Registration (GMS1)

Patient Details


 

Please help us trace your previous medical records by providing the following information


 

If you are from abroad


 

If you are returning from the Armed Forces


 

If you are registering a child under 5


 

If you need your doctor to dispense medicines and appliances*

*Not all doctors are authorised to dispense medicines


 

NHS Organ Donor registration


 

NHS Blood Donor registration


 

Patient Declaration

Practice Area:

Please check if you live within our practice area by expanding the map.

Guidelines: 

It is very important that this form is filled in accurately or this may mean a delay in receiving your medical records. 

PATIENTS DETAILS

Title – Mr Mrs Miss Ms – Tick the appropriate box according to your marital status.

Surname – Surname or Family name. Please make sure the spelling given, is the same that appears on your passport, driving licence or home office paper work.

Date Of Birth – The date you were born. 

First Names – First name or Forename. Please make sure the spelling given, is the same that appears on your passport, driving licence or home office paper work.

Previous Surname/s – If you are married please state your maiden name or if you have changed your Surname/Family name at any time please state your previous Surname/Family name.

NHS Number – If you know your NHS Number which can be found on a medical card.

Male / Female – Please tick the appropriate box.

Home Address – Please enter clearly your full postal address. 

Post Code – You need to print clearly a full post code.

Telephone Number – Please enter as many forms of contacting yourself by phone.

Your Previous Address in UK – If you were previously registered with a GP Practice then please write the address you were living at when registered. 

Name of previous Doctor while at that address – Please state the Doctors name within the GP Practice where you were registered.

Address of previous Doctor – Please state the area where the GP Practice was.

IF YOU ARE FROM ABROAD – Your first UK address where registered with a GP,  Date of leaving  and Date you first came to live in UK – 

IF YOU ARE RETURNING FROM THE ARMED FORCES

Address before enlisting – Please state the address where you were last registered with a GP practice before enlisting.

Service or Personnel number – This can be found on your Discharge Papers.

Enlistment Date – This can be found on your Discharge Papers.

If you want to be added to the NHS Organ Donor Register, and/or NHS Blood Donor Register, please complete that section. 

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