Family doctor services registration (GMS1)

The practice covers the area of Alcester. If you change your telephone number or move locally, please ensure that you inform the practice, so that we have up to date information on you.

From the 5th January 2015 we can now accept out of area registrations. So if you are moving out of our area and would still like to be a patient here, just ring us and let us know. There are visiting restrictions to this but we are happy to discuss this with you. However if it is not clinically appropriate to continue to provide services under the Contract to the patient we may have to ask the patient to register to a closer surgery. Equally if you don’t live in Alcester or the surrounding villages but would like to register with us we can now offer this service.

Patients who wish to register with the Practice will be asked to show some form of identification such as a utility bill, or proof of residency in the UK. We will also need some proof of date of birth, so please show either your Passport or your Birth Certificate. You will also be asked to complete a Health Questionnaire. If you are suffering from a long-term illness such as diabetes or a heart condition.

To register with the practice you can either download our registration document below, print it out, complete it and then bring it into the practice.

Click here to download our Registration Form (.pdf)

Alternatively you can complete the online form below.

All patients over 16, can you please complete the New Patient and patient ethnic questionnaire.  We also need a copy of either a birth certificiate, passport or driving licence for everybody that is registering.  We ask that you print it off and drop it in to the surgery with your date of birth proof.  Many thanks.

New Patient Questionnaire  (.doc)

Paient Ethnic Origin Questionnaire  (.doc)

Patient’s details


Please provide in the format dd/mm/yyyy
If you know your NHS Number, please provide it


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

If you are from abroad

If you are returning from the Armed Forces

If you are registering a child under 5

If you need your doctor to dispense medicines and appliances


Not all doctors are authorised to dispense medicines

NHS Organ Donation registration


For more information, please ask at reception for an information leaflet or visit the website www.uktransplant.org.uk, or call 0300 123 23 23.

NHS Blood Donor Registration


For more information, please ask for the leaflet on joining the NHS Blood Donor Register.

For all patients who are not ordinarily resident in the UK

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.



A parent/guardian should complete the form on behalf of a child under 16.

Non-Uk European Health Insurance Card (EHIC), Provisional Replacement Certificate (PRC) Details And S1 Forms

Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.




How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

9 Confirm

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Your Neighbourhood Professionals
© Neighbourhood Direct Ltd 2017
Fields Park Drive, Alcester Warks, Warks, B49 6QR
Practice Website supplied by Oldroyd Publishing Group
Your Neighbourhood Professionals
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