logo
Text Size:

Registration

If you live within our practice area and would like to register as a patient with North Shore Surgery practice, you can submit your application in a number of ways:

  1.  You can fill in the online per-registration form below. On your first visit to the surgery you will need to sign the form to confirm that the details it contains are correct.
  2. You can visit the surgery and ask the recption staff for a registration form.
  3. You can print off a registration form and GMS1 form, complete it and bring it in with you when you first visit the practice.

GP Registration Form Download          GMS1 Form Download

Online Pre-registration

  • Patient Details

  • Previous GP Details

  • If no previous GP enter: None
  • Next of Kin

  • Additional Patient Information

  • The following questions relate to your parents, brothers, sisters and grandparents:
  • What is your smoking status?
  • We strongly advise against smoking. If you require help/support with stopping smoking please contact Stop Smoking Services on 0300 1231044

  • Alcohol

    1 drink = ½ pint of beer or 1 glass of wine or 1 single spirit
  • Current Medication

    Please list all medications you are currently taking:
  • Include Name, Strength & Dosage
  • Include Name, Strength & Dosage
  • Include Name, Strength & Dosage
  • Include Name, Strength & Dosage
  • Ethnic Origin

    This questionnaire follows the recommendations of the Commission for Racial Equality and complies with the Race Relations Act.

    Please indicate your ethnic origin. This is not compulsory, but may help with your healthcare, as some health problems are more common in specific communities, and knowing your origins may help with the early identification of some of these conditions.
  • Carer Information

  • Other Information

  • Confirmation


    We cannot guarantee that the internet is secure, and the transmission of data is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions. If you do not wish to use the online form, please pop into surgery and pick up a registration form.