Adult Online Registration | Prince Of Wales Group Practice

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Before registering...

Our ‘catchment’ area: We can only register people who are currently resident within our catchment area, so before applying please ensure you reside inside this boundary by using our postcode checking application on this webpage (opens a separate window)

Information to have ready: Our online registration form only takes around 10 minutes to complete although various information needs to be available beforehand such as your NHS Number if known; your previous doctor’s address if applicable; the date of arrival in the UK if from abroad; your Armed Forces personnel number and enlistment date (if you served); and finally some health data like height, weight, and any allergies present which is useful in case of delays receiving your previous medical record. More information if needed can be found here.

If you have any questions about this process please call us on 020 7267 0067.

About the person completing this form

I am registering: *

Myself

Someone else

Your full name: *

Relationship to person you're registering: *

Patient details

Title

Mrs

Miss

Surname *

First names *

Previous surname(s)

Preferred calling name (optional)

Preferred pronoun (optional)

NHS No.

Date of birth *

Gender *

Male

Female

Town of birth

Country of birth

Home address *

Postcode *

Home or Mobile no. 1 *

Home or Mobile no. 2

Work phone no.

Email address *

Your next of kin

Next of kin's name

Relationship to you

Their phone number

Your previous medical information (if applicable)

Have you registered with us before? *

Yes

Your previous address in UK *

Previous doctor's name while at that address *

Address of previous doctor *

If registering with us from abroad

Are you from abroad? *

Yes

Date you first came to live in UK *

First UK address where registered with a GP *

If previously resident in UK, date of leaving

If returning from the Armed Forces

Address before enlisting

Service or Personnel number

Enlistment date

If you are registering a child under 5

I wish this child to be registered with the named doctor for Child Health Surveillance

If you need your doctor to dispense medicines and appliances

I live more than 1 mile in a straight line from the nearest chemist

I would have serious difficulty in getting them from a chemist

If you are human, leave this field blank.