Register online form - St George's Road Surgery

What is your name?

Title

Please select your title

First name

Please enter your first name

Middle name(s)Optional

Last name

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I have recently changed my last name

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How can we contact you?

Email address

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Phone numberWe recommend using your mobile number.

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We'll use these details to update you on the status of your application.

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What is your address?

Search for your address...

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What is your sex as recorded on your NHS record?

Female

Intersex

Male

Not specified or known

Please select one

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What is your date of birth?

For example, 15 3 1984.

Day

Month

Year

Please enter a valid date of birth

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Have you registered with a GP before?

Yes

No

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Have you recently moved from abroad?

Yes

No

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Are you on any repeat medications?

Yes

No

Prefer not to say

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Finally, please confirm your details are correct

Personal details

Email address		Edit
Phone number		Edit
Gender		Edit
Ethnicity	,	Edit
Date of birth	–– / –– / ––––	Edit

I understand that by registering, I am switching my NHS GP practice to St George's Road Surgery.

I agree to the use of my contact details by St George's Road Surgery to send texts or emails about research and other health services.

I would like important information from my GP record to be available to other health and care professionals and give permission to share a Summary Care Record. Learn more

What is your name?

How can we contact you?

What is your address?

What is your sex as recorded on your NHS record?

What is your ethnic group?

What is your date of birth?

Parent or guardian details

Have you registered with a GP before?

Has your home address changed since you last registered?

What was your previous postcode?

Were you ever registered with an Armed Forces GP?

Have you recently moved from abroad?

Where were you born?

Enter details of where you were born

When did you enter the UK?

Have you moved to the UK from the EU, EEA or Switzerland?

Do you have any of these documents?

European health insurance card details

Do you need an interpreter for your appointments?

What is your preferred language?

Have you ever lived at a previous UK address?

What was your previous UK address?

Are you on any repeat medications?

Do you have an emergency contact?

What are the details of your emergency contact?

Finally, please confirm your details are correct

Personal details

Please note

You are eligible to register

You are eligible to register