New Patient Registration - Adults

Our practice is offering online registration, this is open to residents in Newham, but within our catchment area. (Please see the map of our catchment area)

Registering via the following website:

To register visit https://www.eastlondonregistergp.nhs.uk, enter your postcode and choose from the selection. You will be asked to fill a form and submit your personal information, so we can register you.

PLEASE NOTE:
ONCE THE APPLICATION FOR NEW PATIENT REGISTRATION IS SUBMITTED, IT TAKES ABOUT 7-10 WORKING DAYS TO GET REGISTERED. WE WILL NOTIFY ONCE YOU ARE REGISTERED ON OUR SYSTEM.

You do not have to show any ID or proof of address to register.

Click here to download FAQ's about this process (.pdf, 276KB).

If you currently reside within our Practice Boundary you can begin your registration as a 'New Patient' by completing the GMS1 registration form AND the New Patient Health Questionnaire.

To save you time and ensure that you register with the right Practice, please use the catchment map.

Registering with our Practice - completing the GMS1 patient registration form

When filling in the registration form it is important that the form is fully completed to comply with the Health Authority requirements:

Previous surname (if any)
Town and country of birth
Home address with postcode
Telephone number
Previous address
Name and address of previous GP
If appropriate, date of arrival in the UK

New Patient Registration - Adults

Title

First names

Surnames

Previous surnames

Date of Birth

Gender

Town and country of birth

NHS Number

Address

Home Telephone

Work Telephone

Mobile Telephone

Do you consent to being contacted by SMS on this number

Do you consent to being contacted by email at this address

It is your responsibility to keep us updated with any changes to your telephone number, email & postal address. We may contact you with appointment details, test results or health campaigns

Next Of Kin Details

Next of Kin Name

Next of Kin Telephone:

Relationship to you

Family Registered With Us

Please help us trace your previous medical records by providing the following information

Your previous address in UK

Name of previous GP practice while at that address

Address of previous GP practice

If you are from abroad

Your first UK address where registered with a GP

Date you first came to live in UK

NHS Organ Donor registration

Please tell your family you want to be an organ donor. If you do not want to be an organ donor, please visit www.organdonation.nhs.uk or call 0300 123 23 23 to register your decision.

I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death. Please select the boxes that apply.

Any of my organs and tissue or

Kidneys

Heart

Liver

Corneas

Lungs

Pancreas

NHS Blood Donor registration

Would you like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood.

Have you given blood in the last 3 years

My preferred address for donation is: (only if different from above, e.g. your place of work)

PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

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.

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 understand that I may need to pay for NHS treatment outside of the GP practice

I understand I have a valid exemption from paying for NHS treatment outside of the GP practice. This includes for

example, an EHIC, or payment of the Immigration Health Charge (“the Surcharge”), when accompanied by a valid visa. I can

provide documents to support this when requested

I do not know my chargeable status

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.

Registration Details

Ethnicity

If other please provide details

Religion

If other please provide details

Communication Needs

What is your main spoken language?

Do you need an interpreter?

Do you have any communication needs?

Carer Details

Are you a carer?

Do you have a carer?

If yes please provide the details below. Only add carer’s details if they give their consent to have these details stored on your medical record

Carer's name

Telephone

Relationship to you

Family History

Please record any significant family history of close relatives with medical problems and confirm which relative e.g. mother, father, brother, sister, grandparent

Asthma

COPD

Epilepsy

Heart Disease

Stroke

Blood Pressure

Diabetes

Kidney Disease

Liver Disease

Depression

Thyroid

Cancer

Other

Allergies

Please record any allergies or sensitivities below

Current Medication

Please check and include as much information about your current medication below. Please give us your previous repeat medication list if possible and a medication review appointment may be needed

Alcohol

Please answer the following questions which are validated as screening tools for alcohol use

How often do you have a drink containing alcohol?

How many units of alcohol do you drink on a typical day when you are drinking?

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?

How often during the last year have you found that you were not able to stop drinking once you had started?

How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?

How often during the last year have you had a feeling of guilt or remorse after drinking?

How often during the last year have you been unable to remember what happened the night before because you had been drinking?

Have you or somebody else been injured as a result of your drinking?

Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?

Smoking

Do you smoke?

Do you use an e-Cigarette?

How many cigarettes did/do you smoke a day?

Would you like help to quit smoking?

Height, Weight & Blood Pressure

Height

Weight

Blood Pressure

Women Only

Do you use any contraception?

Are you currently pregnant or think you may be?

If yes, what is your expected due date

Electronic Prescribing

If you would like your prescriptions to go electronically, please provide details of the pharmacy you would like to use:

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Shrewsbury Road Surgery • Shrewsbury Road, Forest Gate, London, E7 8QP.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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Key Information

New Patient Registration - Adults

Registering via the following website:

Registering with our Practice - completing the GMS1 patient registration form

Privacy Protection