Register Online

To register with our practice please complete this form as fully as possible. All fields marked * are mandatory and must be completed.

If you need any assistance completing the form please contact the practice.

New Patient Registration

If you are human, leave this field blank.

Fields marked with an asterisk are compulsory*.

Will you be in the area for more than 3 months?

Yes

No

Online registration is not available for temporary residents

Sorry, if you are in the area for less than 3 months we cannot register you via our online form. Please contact the surgery for further information.

Personal Details

Have you registered with this practice before *

Yes

No

Are you a student? *

Yes

No

Gender

Male

Female

Is this your first registration with a GP Practice in the UK?

Yes

No

Date of birth *

Date of birth DD

Date of Birth MM

Date of Birth YYYY

Age *

Title

Forenames

Surname (Family Name)

Previous Surname

Address

Please include any flat, floor and block number or name in your address details.

Postcode

Postcode

Email Address

Enter Email

Confirm Email Address

Confirm Email

Home Phone Number

Your UK Mobile Number

We require your UK mobile number to contact you with any questions. We cannot dial any number outside UK. If you do not have a UK mobile number please enter 0.

Your occupation

Community Health Index (CHI) Number

From your current medical card.

NHS Number

From your current medical card.

Town of Birth

From your birth certificate.

Country of Birth

From your birth certificate.

Registered District of Birth

From your birth certificate. (Scotland only)

Mother's Maiden Name

From your birth certificate.

What is your ethnic group

White Scottish

Other white British

Irish

Other white ethnic group

Indian

Pakistani

Bangladeshi

Chinese

Other Asian ethnic group

Black British or African

Black Caribbean

Other black ethnic group

Other background

Students

How long are you studying in Glasgow?

Have you had the Meningitis ACWY Vaccine?

Yes

No

Have you had the MMR Vaccine?

Yes

No

Name of next of kin

Phone number of next of kin