Stoke Gifford Medical Centre

0117 9799430

Patient registration form

you must complete this for and the new patient health questionnaire to allow us to process your registration. Please complete the form below as fully as possible to allow us to process your application as efficiently as possible.

Please do not use this form if you are trying to register as a Temporary patient. Please contact Reception instead.

  • Patient's details

  • Date Format: DD slash MM slash YYYY
  • Please help us trace your previous medical records by providing the following information


  • If you are from abroad


  • Were you ever registered with an Armed Forces GP

  • Date Format: DD slash MM slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Footnote: These questions are optional and your answers will not affect your entitlement to register or receive services from the NHS but may improve access to some NHS priority and service charities services.
  • *Not all doctors are authorised to dispense medicines
  • Please tell your family you want to be an organ donor. If you do not want to be an organ donor, please visit www.organdonation.nhs.uk or call 0300 123 23 23 to register your decision.
  • I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood.
  • All blood types are needed, especially O negative and B negative. Visit www.blood.co.uk or call 0300 123 23 23.
  • I agree that I may be contacted from time to time, via email and/or SMS with practice news, advice about my health and/or appointment reminders.
  • This field is for validation purposes and should be left unchanged.