Application to Register with a General Medical Practitioner

Personal Details
First registration with a GP in the UK?
First registration with a GP in the UK?
Will you be in the area for more than 3 months?
Will you be in the area for more than 3 months?
If 'no' then ask for form GMSTRF001"
Date of Birth


The following information can be found on your current medical card
The following information can be found on your birth certificate
Please help us to trace your medical records by providing the following information:
If you are from abroad
Date you first came to live in the UK
If returning from abroad, date of departure from UK
If you have served in the British Armed Forces
Enlistment date
Are you a reservist?
Leaving date
Is this your first registration with a GP since leaving the armed forces?
Voluntary Authorisation for Organ or Tissue Donation
You have a choice about organ donation after your death. To find out more about why it is important that you take the time to make sure your donation decision and record it, go to
Organ donation            

How we use your information

The information you have provided will be used by the GP Practice 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 cards, medical exemption certificates and entitlement cards.

NHS National Services Scotland shares information about you within NHSScotland to assist in the provision and improvement of NHS services and the health of the public. When we do this, we make sure that the information which identifies you as a person and your health information are separated or anonymised. Health condition and treatment information which could identify you will not be used for research purposes by the NHS unless you have consented to this.

For more information on how NHS National Services Scotland uses your personal information visit If you have any queries or concerns about how your personal information is used by the NHS please ask for the leaflet ‘Confidentiality – it’s your right’, visit the Health Rights Information Scotland website at or ask your GP surgery. NHS National Services Scotland is the common name of the Common Services Agency for the Scottish Health Service.

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, relevant information from this form will be disclosed to the NHS Business Services Authority, NHS National Services Scotland, the Home Office, Identity and Passport Service, HM Revenue and Customs, the General Register Office and Local Authorities.


Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration.

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.

About This Form

Fields marked with a red asterisk are

You should only send this form if you are sure that you are eligible to join this practice.

Sending this form will NOT automatically register you with the surgery.

Your details will be kept at the surgery and must be signed by you during your first appointment.

Sending this form does NOT guarantee or even imply that you will be accepted onto the practice register