New Patient Registration

If you would like to register with the practice please use this form.

We register New Patients if they are in our catchment area which includes most of the Stevenage area.

We have been advised by NHS England not to register patients who are already registered with a gp within Stevenage, especially if have a underling medical condition or are self isolating, These process will be reviewed in June of this year.

Find out about Temporary Registration.

New Patient Registration

Patient's Details

Please select which surgery you would like to register with: *
Title *
Please use this date format: DD/MM/YYYY.
Gender *
Please tick all the statements that apply to you:

Previous Details

Please include postcode.

If you are from abroad

Registering for the first time in the UK

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

If you are returning from abroad

Previously been a resident in the UK

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

Emergency Contact / Next of Kin

Are they your Next of Kin? *
Do you give us permission to discuss your medical records with them? *

If you are registering someone under 16

Who else lives in your household?
Does this child have contact with any of the following?
Has this child ever been under a child protection plan?
Does the above Emergency Contact / Next of Kin have parental responsibility for this child?

Nominated Pharmacy Information

Communication Needs

Do you have any communication needs?
Do you have a learning disability?
Please request a Learning Disability Screening Tool form

Carers

Do you have a carer? *
Are you a carer for someone? *
Do you give us permission to discuss your medical record with your carer? *

Ethnicity

Please specify the ethnic group you consider you belong to: *
Do you speak English? *
Do you read English? *
Do you require an interpreter? *

Allergies

Do you have any allergies? *