Adult Online Registration

Adult Online Registration Form
0% Complete
1 of 3

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: *

Patient details

Gender *

Your next of kin

Your previous medical information (if applicable)

Have you registered with us before? *

If registering with us from abroad

Are you from abroad? *

If returning from the Armed Forces

If you are registering a child under 5

If you need your doctor to dispense medicines and appliances