Transcript Slide 1

How to fill in your GP Registration Form
Please complete in BLOCK CAPITALS AND  as appropriate
Title: Please  the
appropriate box according to
your marital status
Date of birth: Please enter in
DD/MM/YY format
NHS No.: If you have this
please enter, if not leave
blank. This is NOT your
National Insurance Number
Male/Female: Please  the
appropriate box
Home Address: Please print
clearly your UNIVERISTY
TERM TIME ADDRESS,
including postcode. If you do
not have this yet and you are
in University Halls, please
enter the following address:
University of Chester,
Parkgate Road, Chester, CH1
4BJ. However, please ensure
you update your new GP
Surgery of your exact address
during Induction Week
Your previous address in
the UK: Please print clearly
your CURRENT HOME
ADDRESS
Signature of Patient: Please
sign and date the form. Sign
and  if you are representing
the patient
Surname/First names: Please
make sure the spelling given is
the same that appears on your
passport/driving license
Town and country of birth:
Please insert: e.g. Stockport,
UK
Telephone number: Insert a
telephone number that you may
be contacted on whilst at your
university term time address
Name of previous doctor
while at that address/Address
of previous doctor: Please
enter details of your CURRENT
GP Surgery
If you are from abroad:
Date you first came to live in
the UK: If this is your first time
in the UK, please fill in the date
you will be coming into the UK.
Your first UK address where
registered with a GP: Please
only fill this in if you have
previously lived in the UK and
been registered with a doctor in
the UK.
Please fill in the reverse if
you would like to join the
NHS Organ or Blood Donor
Registers (up to section To be
completed by the doctor).