Send registration

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

Yes, this is my first registration

No, I have been registered previously

Will you be in the area for more than three months?

Yes, I will remain here for more than three months

No, I will be here for less than three months

Your gender

Female

Male

Title / prefix

Surname / last name

Forename(s) / given names

Has your surname changed since birth?

No, it has not changed

Yes, it has changed

Previous surname / last name

Full address

Post code

Important information

The supplied phone numbers and email address will not be input to, or updated in, the Community Health Index (CHI), but will be held on the GP Practice’s system.

Phone number

Mobile phone number

Email address

Helpful tip

The following information can be found on your current medical card. If you do not know these details, they can be left blank.

Community Health Index (CHI) number

NHS number

Helpful tip

The following information can be found on your birth certificate:

Town of birth

Country of birth

Registered district of birth (if born in Scotland)

Mother's maiden name

2. Help us to trace your previous GP health records by providing the following information.

3. 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 NHS Scotland 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’.

4. 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 declaration

I have read and understood the "How we use information" and "Patient declaration" sections above.
By ticking this box, it is considered your signature.

Request email receipt

If you would like a copy of your submission, please tick the box below and supply an email address.

1. Your personal details

2. Help us to trace your previous GP health records by providing the following information.

3. How we use information

4. Patient declaration

Patient declaration

Request email receipt

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