New Patient Registration - Under 16's

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This registration form is for patients under 16.

This form is for under 16s only. If the patient is over 16, please use the Adult Registration Form.

 
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Your child's personal details

Information we need to register you with the practice
Please note all fields marked with a * are mandatory for your registration

If any
You can find your child's NHS number in their red book.
If they have not started talking, please let us know what language they will be learning as their first language
If you will be attending appointments with your child and you do not speak English, please answer 'Yes' to this question.
 
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Your child's current address
 
Eg: "9PU"
 
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Medical Records

Help us trace your medical records.

Please supply your previous full address in the UK (the address you used when last registering with a GP practice)

NHS Organ Donor Register

The law around organ donation in England changed to an opt-out system, to enable more people to save more lives.

This means that unless you choose to opt out, or are in an excluded group, you will be considered to have agreed to be an organ donor when you die.

The best way to make your decision known is to record it on the NHS Organ Donor Register and tell your loved ones.

FIND OUT MORE ABOUT ORGAN DONATION

Across the rest of the UK

NHS Blood Donor registration

Giving blood saves lives.The blood you give is a lifeline in an emergency and for people who need long-term treatments.

This means that unless you choose to opt out, or are in an excluded group, you will be considered to have agreed to be an organ donor when you die.

The best way to give blood is to apply using the NHS Blood Donor Register

FIND OUT MORE ABOUT BLOOD DONATION

We need

  • Nearly 400 new donors a day to meet demand
  • Around 135,000 new donors a year to replace those who can no longer donate
  • 40,000 more black donors to meet growing demand for better-matched blood
  • 30,000 new donors with priority blood types such as O negative every year
  • More young people to start giving blood so we can make sure we have enough blood in the future
 
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About them
 
 
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Your child’s significant medical history
 
e.g. bowel cancer, breast cancer etc
 
This means someone who is unable to leave their home environment due to a physical or psychological illness

We require documentation in relation to these arrangements.

  • You upload photo, scan or document
 
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Medications

Please provide details of any medications they are currently being prescribed

Eg: Asthma, Diabetes etc
Eg: Asthma, Diabetes etc
Eg: Asthma, Diabetes etc

In an effort to support the NHS Paper Switch-Off Programme (PSO) we will no longer be printing prescriptions

 
 
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Allergies

Please provide details

 
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Family History
High Blood Pressure, Diabetes, Mental Illness, Stroke, Cancer, Heart Attack, Asthma etc
 
 
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Carers

A carer is anyone, including children and adults who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.

 
 
 
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If they are from abroad
If they are returning from abroad

Previously been registered with the NHS in the UK

 
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Supplementary Questions

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 at reception. Alternatively for more information go to the NHS Website

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.

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate
action may be taken against me.

A parent/guardian should complete the form on behalf of a child under 16.

European Economic Area (EEA) Country

If they 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 enter the details from their EHIC or PRC below.

S1 Form

Please give your S1 form to the practice staff.

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.

 
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Name(s) of person(s) with parental responsibility
For example: Mother, Father, etc.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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