Application to Register with a General Medical Practitioner - GPR (Scotland)77159

Application to Register with a General Medical Practitioner - GPR (Scotland)77159

ALL FIELDS MARKED * ARE MANDATORY AND MUST BE COMPLETED AS FULLY AS POSSIBLE

  • 1. Personal Details

    Is this your first registration with a GP Practice in the UK?
    Date of Birth
    For example, 15 3 1984
    Sex at Birth
    What is your gender?
    Will you be in the area for more than 3 months? - If ‘No’, please complete a temporary resident form available at the practice from the reception desk.

  • If you are from abroad

    Date you first came to live in the UK (optional)
    For example, 15 3 1984
    If returning from abroad, date of departure from UK (optional)
    For example, 15 3 1984

  • If you have served in the British Armed Forces

    Enlistment date (optional)
    For example, 15 3 1984
    Are you a reservist? (optional)
    Leaving date (optional)
    For example, 15 3 1984
    Is this your first registration with a GP since leaving the armed forces? (optional)

  • Patient Declaration

    I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, the minimum necessary information from this form could be disclosed to relevant authorities. I understand that more comprehensive information about how NHS Scotland handles my data is available from NHS Inform. This information can be provided in other languages and formats on request. The NHS Inform helpline provides an interpreting service

    Date
    For example, 15 3 1984
    Patient's / Patient's representative Digital Signature :

  • Newbyres Medical New Patient Questionnaire

    Have you been a patient and registered with us before.
    Do you need a language interpreter or BSL interpreter.
    Ethnic group
    Have you ever suffered from? (tick as appropriate)
    Are you registered disabled?
    Are you registered housebound at your previous practice
    Are you allergic to any medicines?
    Do you have a carer?
    Smoking - Do you smoke?
    If 'No', have you ever smoked?
    Please select a nominated pharmacy you would like your prescriptions to be sent to.
    Would you like a new patient medical with our Health Care Assistant which includes - Blood Pressure, Weight, Height and urine test.

  • Online Services - Patient Details

    To make use of our online services like requesting repeat prescriptions and viewing appointments you will need to opt in by giving us your consent to opt in to online services, SMS communications, and all other digital communications from our practice.

    You will need to re register at www.patient-services.co.uk to use our online prescription repeat request service. 

    By submitting this form, you are confirming that you understand and agree to our data usage policies as per the GDPR guidelines. You also confirm that you are over 16, or have parental permission to use these services.

    Do you agree to opt in to our online services like requesting repeat prescriptions and viewing appointments via www.patient-services.co.uk and receive appointment reminders and health updates through SMS?
    Do you consent to being contacted by SMS Text/Email for Appointments/Recalls/Results or Information from our clinicians or medical admin team.
    By using Our site, you consent to such processing and you warrant that all data provided by you is accurate. Your registered e-mail address will be used by Newbyres Medical Group GP practice to send reminders and notifications. If you are sharing an e-mail address, those reminders and notifications will be viewable by any user of that shared e-mail address.

  • GP/ADMIN USE ONLY

  • Voluntary consent to organ donation

    You have a choice about organ or tissue donation after your death. To find out more about why it is important that you take the time to make your donation decision and record it, go to www.organdonationscotland.org

  • How we use your information

    The information you have provided will be used by the GP Practice to carry out its various functions and services including scheduling appointments, ordering tests, hospital referrals and sending correspondence. Your information, including your name, gender, date of birth and address, will be passed to NHS National Services Scotland where it will be held on the Community Health Index (CHI). This information is used to register you with the GP Practice, transfer your medical records between GP practices in the UK, make payments to GP Practices for medical services provided, and to process and issue medical cards, medical exemption certificates and entitlement cards. NHS National Services Scotland shares information about you within NHSScotland to assist in the provision and improvement of NHS services and the health of the public. When we do this, we make sure that the information which identifies you as a person and your health information are separated or anonymised. Health condition and treatment information which could identify you will not be used for research purposes by the NHS unless you have consented to this. For more information on how NHS National Services Scotland uses your personal information visit http://www.nhsnss.org. If you have any queries or concerns about how your personal information is used by the NHS please ask for the leaflet ‘Confidentiality – it’s your right’, visit the Health Rights Information Scotland website at http://www.hris.org.uk or ask your GP surgery. NHS National Services Scotland is the common name of the Common Services Agency for the Scottish Health Service.

  • Privacy and security

    Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration for example you can collect a registration form from reception. Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Page last reviewed: 06 October 2025
Page created: 19 June 2024