01. Application to Register Permanently

Name

This field is for validation purposes and should be left unchanged.

PATIENT DETAILS

Is this your first registration with a GP Practice in the UK?(Required)

Yes

Will you be in the area for more than 3 months?(Required)

Yes

Please do not continue with this form, you must complete a temporary resident form

Sex(Required)

Male

Female

Date of Birth(Required)

Title(Required)

Surname(Required)

Forenames(Required)

Previous Surname

Address including postcode(Required)

Telephone #(Required)

Mobile #(Required)

Email(Required)

Community Health Index (CHI) number(Required)

NHS number(Required)

Town of birth(Required)

Country of Birth(Required)

Registered district of birth

Mother’s maiden name

HELP US TO TRACE YOUR PREVIOUS GP HEALTH RECORDS BY PROVIDING THE FOLLOWING INFORMATION

Address in UK when you were last registered with a GP(Required)

Name and address of previous GP Practice in UK(Required)

Are you from abroad?(Required)

Yes

Date you first came to live in the UK(Required)

If previously resident in the UK, date of leaving(Required)

Your most recent country of residence(Required)

Have you served in the British Armed Forces(Required)

Yes

Service Number(Required)

Enlistment date(Required)

Are you a Reservist?(Required)

Yes

What was your address before enlisting?(Required)

Leaving Date(Required)

Is this your first registration with a GP since leaving the armed forces?(Required)

Yes

VOLUNTARY AUTHORISATION FOR ORGAN OR TISSUE DONATION

You have a choice about organ or tissue donation after your death.

For more information on being an organ donor or privacy, please ask for the leaflet on joining the NHS Organ Donor Register or visit www.organdonationscotland.org

HOW WE USE INFORMATION

The information you have provided will be used by NHS Scotland to carry out its various functions and services including scheduling appointments, ordering tests, hospital referrals and sending correspondence.

Your information, including your name, gender, date of birth and address, will be passed to NHS National Services Scotland where it will be held on the Community Health Index (CHI). This information is used to register you with the GP Practice, transfer your medical records between GP practices in the UK, make payments to GP Practices for medical services provided, and to process and issue medical exemption certificates and entitlement cards.

NHS National Services Scotland shares information about you within NHSScotland to assist in the provision and improvement of NHS services and the health of the public. When we do this, we do it as described by NHS Scotland in the NHS Inform website under the “How the NHS handles your personal health information” section.

NHS Scotland is made up of various organisations such as NHS Health Boards, GP practices, the Scottish Ambulance Service or NHS National Services Scotland (the common name of the Common Services Agency for the Scottish Health Service). These organisations are individually responsible for your personal health information. In terms of data protection and privacy laws, they are known as ‘data controllers’.

Find out more about NHS Scotland in the link provided above.

PATIENT DECLARATION

I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, the minimum necessary information from this form could be disclosed to relevant authorities.

I understand that more comprehensive information about how NHS Scotland handles my data is available from NHS Inform.

This information can be provided in other languages and formats on request. The NHS Inform helpline provides an interpreting service.

Patient / Patient’s representative signature(Required)

Your Name
Your Name
Your Name

Representative’s name (if applicable)

Relationship to patient (if applicable)

Opening Times

Monday08:00am to 06:00pm
(Doors open 8:30am to 12:30pm then 1:30pm to 5:30pm)
Tuesday08:00am to 06:00pm
(Doors open 8:30am to 12:30pm then 1:30pm to 5:30pm)
Wednesday08:00am to 06:00pm
(Doors open 8:30am to 12:30pm then 1:30pm to 5:30pm)
Thursday08:00am to 06:00pm
(Doors open 8:30am to 12:30pm then 1:30pm to 5:30pm)
Friday08:00am to 06:00pm
(Doors open 8:30am to 12:30pm then 1:30pm to 5:30pm)
SaturdayCLOSED
SundayCLOSED

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