Register as a New Patient

To register at our GP Practice please submit this health questionnaire. Please then visit either surgery with your photo ID and proof of address to verify your identity (a driving licence will meet both criteria).

New Patient Registration

Patient's Details

Title
Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Sex: *
Gender Identity:
Gender at Birth:

Blood Pressure

SMS Consent

Do you consent to receive text messages from Attleborough Surgeries?

Email Consent

Do you consent to receive email communications from Attleborough Surgeries?

Preferred Method of Communication

What is your preferred method of communication?

Next of Kin

GP History

Please help us trace your previous medical records by providing the following information:
Please include postcode.
Please include postcode.

If you are from abroad

Registering with the NHS for the first time in the UK
Please use this date format: DD/MM/YYYY

If you are returning from abroad

Previously been registered with the NHS in the UK
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Background

Please specify the ethnic group you consider you belong to:
Housing status:
Employment Status:
Passport Status:
EHIC:
Armed Forces:

Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY

Communication Needs

Do you require an interpreter?

Carers

Are you a carer?
I care for:
Do you have a carer?
Does your carer consent for their details to be held on your medical record?