Before you proceed...
Out of Area Registrations
Unfortunately, we are not able to provide any home visits for patients who live out of our catchment area. Therefore we will only accept registrations for patients where we do not expect that home visits will be needed for you in the near future.
Should you find yourself in the situation that you do require a home visit you can contact NHS 111 who will be able to help you.
Other than this out of area patients are entitled to the same level of medical care from our practice as any other patient.
The practice will look at your application and review it which may include being asked to come in for a consultation. Until that time your registration will be on a provisional basis. A decision will then be made on an individual patient basis as to whether it is appropriate for you to be registered as an Out of Area Registration and you will be informed within 14 days if your request has been rejected.
Your registration is not guaranteed to be accepted and the practice will be unable to provide you with home visits.
Why would you like to register as an out of area patient with our practice?
How often do you stay or visit our practice area and why?
Are you wanting to register on your own, or do you have family members who need to register? (We would require separate forms for each family member)
Are you completing this form on behalf of...
Have you registered for General Medical Services in the UK before?
Town and Country of Birth
Please help us trace your previous medical records
Previous address in the UK
Name of previous doctor or name of surgery while at that address
Address of previous doctors surgery
Patients new to the UK only
Are you new to the UK from abroad?
Your first UK address where registered with a GP
If previously resident in UK, Date of leaving
Date you first came to live in UK
Anybody in England can register with a GP practice and receive free medical care from that practice.
However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice.Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.
Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.
More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice.
You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.
The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.
Please select one of the following options:
Non-UK European Health Insurance Card (EHIC), Provisional Replacement Certificate (PRC) Details and S1 Forms
All patients with EHIC, PRC or S1 are now able to self-declare on registration with a GP Practice. Please fill in these details on the registration form if you have a EHIC, PRC or S1 form
Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.
If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.
Please tick if you have an S1 (e.g. you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state). Please give your S1 form to the practice staff.
Do you have a non-UK EHIC or PRC?
How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process. Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.
Date of Birth
Personal Identification Number
Identification number of the institution
Identification number of the card
PRC Validity Period: From