New Patient Registration

If you would like to register with the practice, please use this form.

To register a new patient you will need to live within our practice boundary.

This must be completed by all new patients, including on behalf of children. You may be contacted to answer some questions to confirm your identity.

If you need help completing this form, please telephone the practice to arrange this.

If you are ill while away from home and need to see a doctor you can receive emergency treatment from the doctors at Cranleigh Medical Practice. You will need to register as a temporary patient.

You can be registered as a temporary patient for up to three months. This will allow you to be seen by us for emergency care but still remain registered with your permanent GP.

You cannot register as a temporary patient at a practice in the town or area where you are already registered.

New Patient Registration - Cranleigh

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Sex *
Any responses we send will go to this email address.

If you have provided your mobile number, the practice is able to send you SMS (texts) for the following:

  • Appointment confirmations and reminders
  • Annual review invitations
  • Changes to your booked appointment
  • Cancelled clinics, including GP, Nurse and Healthcare Assistant
  • Test results (where appropriate)
  • Other notifications the practice deem necessary to your healthcare provision

The mobile number will only be used by the GP practice and will not be passed to any other parties.

It is your responsibility to maintain the safety of your mobile to avoid anyone else being able to access SMS (text) sent to you.

Please inform us of any change in your mobile number, or if you no longer wish to use this facility.

Please select as appropriate:
Can we contact you by email?

Ethnicity

Please specify the ethnic group you consider you belong to:
Do you speak English?
Do you read English?
Consultations are carried out in English. Please indicate if you will need the services of an interpreter:

Emergency Contact

Are they your next of kin?
Do you give us permission to discuss your medical records with them?

Previous Details

Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK
Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Supplementary Questions

I am not ordinarily a resident in the UK

Ordinarily Resident

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. Alternatively for more information go to www.nhs.uk/visitingengland.

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 statements:

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

For a list of EEA countries visit: www.gov.uk/eu-eea
Do you live in another EEA country, or have moved to the UK to study or retire, or live in the UK but work in another EEA member state?
Do you have a non-UK European Health Insurance Card (EHIC) or a Provisional Replacement Certificate (PRC) ?

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.

EHIC/PRC

Please enter the details from your EHIC or PRC below.

S1 Form

Do you have an 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.

Carers

Are you a carer for someone?

Are you willing for your name to be passed to the carers' organisations?
Is the person you care for registered with this practice?
Do you have a carer?

Is your carer registered with this practice?
Do you give us permission to discuss your medical record with your carer?