New Patient Registration (Child)

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

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

New Patient Registration (Child) - Hillview

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Sex *
Any responses we send will go to this email address. If the patient is under 13 or you wish for correspondence to go to a parent / guardian, please enter the parent / guardian's email address.
Do you live in a residential or nursing home? *
Please specify: *

Parent / Guardian / Carer / Family Details

Parent / Guardian / Carer 1.

Title: *
Do they have legal responsibility? *
Are they your next of kin? *

Parent / Guardian / Carer 2.

Do they have legal responsibility?
Are they your next of kin?

Details of person(s) with legal responsibility if not above:

Does a family member, friend or neighbour help look after you at home? *
Does the parent, guardian or carer give permission for someone else to accompany the child to an appointment? (e.g. Grandparent, child-minder) *
Is your child currently housebound? *
Is your child currently:
Is your child a looked after child under the care of the local authority? *
Please specify: *
Is your child or family currently involved with Childrens Services or have they ever been known to Childrens Services or the safeguarding team? *

Online Services

Would you like to book appointments, request repeat prescriptions and be able to view a summary of your medical records online? *

We will need to post your access details to you once we have created your medical record. If the patient is 13 years or older, the form needs to be signed by the patient.


Can we contact you by email? *
Can we contact you by text? *
Can we leave messages on your answer phone? *
Do you speak English?
Do you read English?
Improving access to the practice in relation to disability or sensory loss is important to us. If your access restricted, please select all the requirements that apply:


Please specify the ethnic group you consider you belong to: *

Previous Details

Has your child/dependent been registered with an armed forces GP previously?
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.

If you are returning from the Armed Forces

Please provide your signed Medical Form FP53 to release your medical records.

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

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:
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.


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.


Do you have any allergies? *


Do you have a carer?
Are you a carer for someone?
Would you like additional support as a young carer?
Are you aware of services such as young carers?
Has the person you care for given consent for their details to be shared?
Do you give us permission to discuss your medical record with your carer? *