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Family doctor services registrations

Please complete as fully as possible.Please skip the sections that do not apply to your situation.Please fill in one form per family member you are registering.

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

If you are from abroad

Please leave this section blank if this does not apply to you

If you are returning from the Armed Forces

Please leave this section blank if this does not apply to you

NHS Organ Donor registration

For more information, please visit the website www.uktransplant.org.uk, or call 0300 123 2323

Supplementary Questions

PATIENT DECLARATION for all patients who are not ordinarily resident in the UK (Please skip if this does not apply to you)

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 i f you have an EHIC issued by the UK.

NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS

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.

This copy WILL NOT be stored and once verified will be suitably deleted in line with GDPR