Online New Patient Registration Process NHSFamily doctor services registrationGMS1 Patient's Details Radio Buttons * Mr Mrs Miss Ms Surname * Date of Birth * DD/MM/YYYY First names * NHS Number Previous surnames Radio Buttons * Male Female Town and country of birth * Home address * Postcode * Telephone number Please help us trace your previous medical records by providing the following information Your previous address in UK Name of previous doctor while at that address Address of previous doctor If you are from abroad Your first UK address where registered with a GP If previous resident in UK, date of leaving Date you first came to live in UK If you are returning from the armed forces Address before enlisting Service or personnel number Enlistment date If you are registering a child under 5 Child Surveillance I wish the child above to be registered with the doctor named overleaf for Child Health Surveillance Checkboxes Signature Signature of behalf of Patient Date