Temporary Patients Registration

Patient's Details

Please specify:

NHS Number:

First Name: *

Surname: *

Previous Surnames:

Home Address: *

Postcode: *

Telephone Number:

Do you have a temporary address? *

Yes

No

Temporary Address: *

Temporary Postcode:

Telephone Number:

Doctor's Details

All details of treatment will be sent to this doctor and address.

Doctor's First Name:

Doctor's Last Name:

Address of Doctor:

Postcode:

Telephone Number:

Were you ever registered with an Armed Forces GP

These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.

Please indicate If you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas:

Regular

Reservist

Veteran

Family Member (Spouse, Civil Partner, Service Child)

Address before enlisting:

Please include postcode.

Service or Personnel Number:

Enlistment date:

Please use format DD/MM/YYYY

Discharge date:

Please use format DD/MM/YYYY

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Patient's Details

Doctor's Details

Were you ever registered with an Armed Forces GP

COVID 19 - An update on visiting the practice