Please fill in your details and click Submit when complete.

Please only complete this registration form once. If you have previously submitted this form at
any time please do not do so again unless advised by the Health Centre to do so. If you are unsure
of your registration status, you can contact the practice who will be able to confirm this for you.

Current patients: DO NOT use this form to update your address or other details.

* = Compulsory

* Is this your first registration with a GP Practice in the UK? Yes   No
* Will you be in the area for more than 3 months? Yes   No
* Title:
* Surname (Family name):
* First name(s):
Previous surname:
Mother's maiden name:
* Date of birth:	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916
NHS Number:
Community Health Index (CHI) Number:
* Gender:	Male   Female   More information...
We appreciate that many people identify as transgender, non binary or intersex. However due to the constraints of the NHS Spine, in order to register you we do need to know the gender you were assigned at birth, or the gender assigned currently on your medical record. If this is something you wish to change or discuss changing, then please after registration make an appointment to discuss taking this further.
* Town of Birth:  * Country of Birth:   Registered district of Birth:
Please select your student accommodation or fill in your new ADDRESS in Edinburgh:
You can check that you live within the practice area by clicking this link.
Student Accommodation:	Select... Arran House Ascham Court Baird House - Pollock Halls Blackwood Crescent Bridge House Buccleuch Place Lane 1-6 Buccleuch Place 7-13 Canal Point Chalmers Chancellor's Court - Pollock Halls Churchill House College Wynd Darroch Court David Horn House Deaconess East Newington Place Edward Salvesen Hall - Mylnes Court Ewing House - Pollock Halls Fleming House Fraser Court Grant House - Pollock Halls Hello Student Hermits Croft Holland Annex - Pollock Halls Holland House - Pollock Halls IQ - Dundee Street IQ - Grove Street John Burnett House - Pollock Halls Kincaids Court Kitchener House Lee House - Pollock Halls Meadow Court New Arthur Place Patrick Geddes Hall - Mylnes Court Philip Henman Hall - Mylnes Court Portsburgh Court Potterow Ratcliffe Terrace Riego Street Robertsons Close Roxburgh Place Salisbury Court South Clerk Street The Old Printworks Turner House - Pollock Halls Vita Student Warrender Park Crescent West Mains Road
Flat/Room:
House/Hall:
* Street Address:
* Town:
* Postcode:
You can check that you live within the practice area by clicking this link.
* Email address:
* Confirm Email address:
* UK Mobile telephone number:
How long is your Course? (if you're a student)
* Do you come from ABROAD?  Yes   No
Fill in if you come from abroad (international student) * Date you first came to live in the UK: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 If previously resident in the UK, date of leaving: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Your most recent country of residence: Are you a refugee from Ukraine? Yes   No
LAST ADDRESS in UK when you were registered with a GP Name and address of PREVIOUS GP Practice in UK House: * Street: * Town: * Postcode: * Practice Name: Street: Town: * Postcode:
* Full name: EMERGENCY CONTACT  * Phone no:   * Relationship:
Have you served in the British Armed Forces? Yes   No Is this your first registration with a GP since leaving the Armed Forces? Yes   No Service or Personnel No: Address: (before enlisting) Town: Postcode: Enlistment date: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Leaving date:   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Are you a Reservist? Yes   No
Voluntary Authorisation for Organ or Tissue Donation You have a choice about organ or tissue donation after your death. To find out more about why it is important to take the time to make your donation decision and record it, go to www.organdonationscotland.org
Communication Consent It is essential we are able to contact you immediately to discuss you health care needs, test results and in any emergency healthcare situation. Please state below how you wish us to contact you about your health care in these situations: By Phone:   By Email:   By Text:   By Post:   (We recommended you tick all of these) Please be aware that failure to agree to any of the above contacts will delay us being able to contact you in an emergency health care situation. Why We Require Consent As part of your medical care we often require to share your clinical information with other services, e.g. Out of Hours Service, Hospitals, Community services and the Ambulance Service. This can be on an emergency or on going basis to facilitate your care and where this is necessary we will share appropriate, relevant and proportionate personal information, in compliance with the law. These organisations need to be fully aware of your medical history and any suggestions we have for your care in the event you become unwell.  To share this information, we require your consent so please note we do not share this information with any other body other than these essential healthcare providers.  If we do not have your consent to contact you then this will affect our ability to provide you with a full health care cover service. * Do you consent to the practice sharing your medical information with emergency services and hospital/community services? Yes   No * Do you consent to the practice sharing your medical information with the Out of Hours Service? Yes   No   Online Services and Text Messaging Services Online Services allows you to: ● Book a routine GP appointment 24 hours per day, 7 days per week through the year ●  Cancel appointments that are no longer required ● Check your medication and order repeat prescriptions ● Amend your mobile phone number and email address where appropriate Text messages allow the practice to send you health promotional information, appointment reminders and information on flu clinics. Please speak to reception staff if you would like to register for these services.   It is extremely important that we are able to contact you regarding your health care and from experience it is useful to be able to do this in a variety of ways such as phone, mail, email and texting. Please consider carefully before saying No to any of the options as this may make contacting you about your health care difficult. In line with GDPR regulations we do require your consent for the practice to contact you by the various methods outlined below so please answer the questions below:- * I consent to the practice contacting me by text SMS: Yes   No * I consent to the practice contacting me by email: Yes   No * I consent to the practice contacting me by post: Yes   No * I consent to the practice contacting me by telephone: Yes   No   Please note that you can opt out of any of the above services at any time by contacting us on 0131 650 2777 or writing to the Practice Manager at the practice address.
How we use your information
The information you have provided will be used by NHS Scotland to carry out its various functions and services including scheduling appointments, ordering tests, hospital referrals and sending correspondence. Your information, including your name, gender, date of birth and address, will be passed to NHS National Services Scotland where it will be held on the Community Health Index (CHI). This information is used to register you with the GP Practice, transfer your medical records between GP practices in the UK, make payments to GP Practices for medical services provided, and to process and issue medical exemption certificates and entitlement cards. NHS National Services Scotland shares information about you within NHSScotland to assist in the provision and improvement of NHS services and the health of the public. When we do this, we do it as described by NHS Scotland in the NHS Inform website under the "How the NHS handles your personal health information" section. NHS Scotland is made up of various organisations such as NHS Health Boards, GP practices, the Scottish Ambulance Service or NHS National Services Scotland (the common name of the Common Services Agency for the Scottish Health Service). These organisations are individually responsible for your personal health information. In terms of data protection and privacy laws, they are known as 'data controllers'. Find out more about NHS Scotland in the link provided above.
Patient declaration
I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, the minimum necessary information from this form could be disclosed to relevant authorities. I understand that more comprehensive information about how NHS Scotland handles my data is available from NHS Inform. This information can be provided in other languages and formats on request. The NHS inform helpline provides an interpreting service.
* Patient/Representative Signature:	Clear
Representative's name (if applicable):
Relationship to patient (if applicable):
Health Questionnaire
* Ethnic origin: Please select... White British White Irish White Scottish Other white, please state Black Caribbean Black African Black, other, non-mixed origin Black British Black West Indian Black Guyana Black North African Black Arab Black Iranian Black - other African country Black East African Asian Black Indo-Caribbean Black Indian sub-continent Black - other Asian Black - other, mixed Indian Pakistani Bangladeshi Chinese Greek Greek Cypriot Turkish Turkish Cypriot Other European, please state Irish traveller Other ethnic group Traveller - gypsy Arab Prefer not to answer Other:
* Do you SMOKE? Yes   No   Used to smoke
Do you DRINK more than the government recommended amount of alcohol? Yes   No
Do you suffer from any ALLERGIES?Yes   No  * Please state any allergies you have: Do you have to carry an adrenaline pen for allergies? Yes   No
Please tick if you are currently receiving treatment for any of the following conditions: ADHD Epilepsy Diabetes Heart Disease Bipolar Disorder High blood pressure Cancer Schizophrenia Coeliac disease Thyroid disease Asthma Immunosuppressed   Sickle Cell   Have you had any emergency admissions to hospital in the past year for your asthma? Yes   No Please provide date and more information: Please enter Date of Diagnosis, Medication and other relevant Information about your condition: * Since you have indicated that you have ADHD, please download this ADHD Patient Questionnaire, complete it and save it and then attach it to this registration form using this button: * Since you have indicated that you have Diabetes, please download this Diabetes Medical Questionnaire, complete it and save it and then attach it to this registration form using this button: Any other significant condition: We will contact you in the next month to arrange a consultation. If you have not heard from us by the end of the month, please call and ask for a new patient consultation.
Are you on regular, repeat MEDICATION at present?Yes   No  (including the pill and depo-injections) * Please list any regular medicines you use:
Have you ever had a SMEAR test?  Yes   No Date: Where: Result:
Do you act as a regular CARER for anyone? Yes  No
VACCINATION HISTORY PNEUMOCOCCAL Vaccination: Are you 65 years or older? Yes   No If No - no action required   Have you had Pneumococcal vaccination?   Yes   No If Yes - no action required       Have you chosen NOT to have one?   Yes   No If Yes - no action required     If No - you may need a Pneumococcal vaccination, We will refer you on to the Area Vaccination Team who will be in contact in due course.
Please read our Privacy Notice.

The information you are submitting will be sent encrypted to the medical practice over the Internet.