New PYB Patient Registration Form (GMS1)

New PYB Patient Registration Form (GMS1)

Fields marked "REQUIRED" are compulsory. You should only send this form if you are sure that you are eligible to join this practice. You must reside with the specified catchment area.

Sending this form will NOT automatically register you at the practice and does NOT guarantee that you will be accepted onto the practice register.

Registrations may take up to 3 working days.

  • Patient's Details

    Date of Birth
    For example, 15 3 1984
    Gender

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

  • If you are not from the UK

    You MUST complete this section if you are not from the UK.

    We cannot proceed with your application if we don't have these details.

    If previously resident in UK, date of leaving (optional)
    For example, 15 3 1984
    Date you first came to live in UK (optional)
    For example, 15 3 1984

  • Additional Information

    This information is required to complete your registration.

    Ethnic Origin
    Are you a smoker? (optional)
    Do you suffer from, or have you ever suffered from any of the following? If so, You MUST book an appointment with our nurse for a new patient check to ensure that we are supporting your needs.. Select none of these if N/A
    Please indicate if you have served in the UK Armed Forces. These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services. (optional)
    Enlistment Date (optional)
    For example, 15 3 1984
    Discharge date (if applicable) (optional)
    For example, 15 3 1984

  • Complete Registration

    *Not all doctors are authorised to dispense medicines

    Signature (optional)
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Page last reviewed: 11 September 2026
Page created: 27 August 2026