Patient Registration2017-05-30T14:30:33+01:00

Patient Registration

Which Practice would you like to register with?
I would like to register with

1st Floor

Moorgate Primary Care Centre

22 Derby Way



Star Suite

Radcliffe Primary Care Centre

69 Church Street West


M26 2SP

Patient Details -
DOBof appointment
Surnameyour full name
NHS No.your full name
First Nameyour full name
Previous Surnameyour full name
Home Addressmore details
0 /
Birth Townyour full name
Birth Countryyour full name
Telephone No.your full name
Postcodeyour full name
I Am A Student At (If Applicable)your full name
Please help us trace your previous medical records by providing the following:
Previous Address In UKmore details
0 /
Name Of Previous GP While At Previous Addressmore details
0 /
Address Of That GPyour full name
If You Are From Abroad:
Your first UK Address Where Registered With A GPmore details
0 /
Date You First Came To Live In UKof appointment
If Previous Resident Of UK, Date Of Leavingof appointment
If You Are Returning From The Armed Forces:
Address Before Enlistingmore details
0 /
Enlistment Dateof appointment
Service/Personnel No.your full name