Join The Practice

We welcome new patients who live within our practice area to register with us. Please view the practice boundary here.

Anyone in England can register with a GP surgery. It's free to register. You do not need proof of address or immigration status, ID or an NHS number.

GP surgeries are usually the first contact if you have a health problem. They can treat many conditions and give health advice. They can also refer you to other NHS services. You do not need proof of ID to register with a GP, but it might help if you have one or more of the following:

Passport | Birth certificate | HC2 certificate | Rough sleepers' identity badge | Hostel or Accommodation registration |Mail forwarding letter

If you're homeless, you can give a temporary address, such as a friend's address, a day centre or the GP surgery address.

Please note: You will be asked to upload the ID proof in case you request online access to medical records.

Join The Practice Request

To register online please ensure that you complete all fields on both the new patient registration form and the health questionnaire that follows once you click ‘submit’.

Please ensure to fill in your Previous address on GP so we are able to trace your medical records.

Registrations will be processed within 2 working days

1
Patient’s Details
2
Health Questionnaire
3
Online Access
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Patient’s Details

Title: *
Sex: *
Is your gender identity the same as the sex you were registered at birth? *

Please provide a mobile telephone number wherever possible. By doing so, you will be automatically enrolled to our text reminder service. We will use this for: contacting you about your health when unable to contact you at home / texting your appointment reminders / responding to your queries / advising when your prescriptions/paperwork is ready / advising you if appointments are cancelled.

Parent/Guardian/Carer

Is your Parent/Guardian/Carer currently registered or in the process of registering, at the practice? *  

Please enter your Parent/Guardian/Carer details below:

Student

Previous Details

Please include postcode.

Abroad

If you have only ever lived at one address please enter the same address here.

Armed Forces

Please indicate if you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas:  

These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.

NHS Organ Donor Registration

Organ donation in England has moved to an 'opt out' system. This means that all adults in England will be considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in one of the excluded groups.

You still have a choice about whether or not you wish to become a donor. If you wish to know more on the law and Opt Out from the register, please visit NHS Organ Donation.

NHS Blood Donor Registration

You can self-register on the NHS Blood Donor Register, if you wish to become a blood donor. Please visit the website to register.

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea

EHIC OR PRC

Please enter the details from your 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.

Next of Kin Details

Are any other family members registered with the Practice?  

Carers

It’s important that everyone who works here at Cippenham Surgery knows you are a carer so that we can offer you help and support if you need it. Anyone who looks after a friend or family member who cannot manage without them, and is unpaid, can register. This includes carers under the age of 18.

Please complete the Carer Information Form, to get your details added to your medical records.

Emergency Contact Details

Emergency Contact Details *  

Patient Participation Group

We have a virtual patient participation group which has been set up in response to patients that have said they would like to be involved in a Patient Group but are unable to attend meetings. This group provides an effective way of patients and the surgery working together to improve services and to promote health and improved quality of care.

If you are interested in joining the group, please complete the Patient Participation Group Registration Form

Ethnic Group

In compliance with the Race Relations (Amendment) Act 2000 and its Race Equality Scheme any new patient registrations are requested to complete this form.

Which of the following best describes your ethnic background? *  
Please Specify  
Please Specify  
Please Specify  
Please Specify  
Please Specify  
Do you need an interpreter?