Register as a temporary patient form

Complete the form to register as a temporary patient at the surgery for up to three months. This will allow you to have use the services and see a GP at our surgery.

If you are not registered with a doctor but need to see one, you can receive emergency treatment from any GP surgery. If you need treatment for more than 14 days, you will need to register as a temporary or permanent patient.

You can register as a temporary patient for up to three months. This will allow you to be on the local practice list and still remain a patient of your permanent GP. After three months you will have to re-register as a temporary patient or permanently register with that practice.

To register as a temporary patient please contact our surgery on 01726 75555. There is a form to complete, which is available below. Practices do not have to accept you as a temporary patient. You cannot register as a temporary patient at a practice in the town or area where you are already registered.

Download Temporary Resident Registration Form

Click here to download the form (PDF)

or complete below

Surname

First name(s)

Previous names (if applicable)

Your date of birth

Sex

Male

Female

Telephone

Email address

NHS No.

An NHS number is a 10-digit number, like 485 777 3456. If known, please enter your NHS number in the field below. You can find more information on the NHS website

Your current home address

Home address (permanent)

Current GP practice name

Current GP practice address

Start date of temporary registration

End date of temporary registration (if known)

Reason for temporary registration

I consent to the temporary registration and care provided by the GP practice

Signature

Write your full name

Date of submitting the form

Important:

Register as a temporary patient form

Download Temporary Resident Registration Form