New Patient Questionnaire PGP

Last Updated: 20/08/2021

Which Surgery are you registering at?

Personal Details

Home Address

Contact Details

Patient Contacts

Please help us trace your medical records by providing the following:

If you are from abroad

If you are returning from the Armed Forces

Carers Group

Your medical history (NOT family history)

Health Information

Current Medication

Practice Services / Groups

Other Information / Patient confirmation

NHS Doner Registration

Supplementary Questions

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 and EHIC issued by the UK.