New Patient Registration

If you would like to register with the practice please use this form.

To register a new patient you will need to live within our practice boundary.

New Patient Registration - Hall Green

New Patient Registration - Hall Green

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
If you were previously registered at another practice please contact the practice to obtain your NHS No.
What sex do you identify with? *
Does your gender identity differ from that which was assigned at birth? *
Please state your sexual orientation: *
Any responses we send will go to this email address.
Can we contact you by text?
Can we contact you by email?
Have you ever been registered with Hall Green Health before? *
Do you have any information or communication needs such as large print or specific coloured paper? *

Ethnicity

Please specify the ethnic group you consider you belong to:
Do you speak English?
Do you read English?

Emergency Contact

Are they your Next of Kin? *
Do you give us permission to discuss your medical records with them? *

Allergies

Do you have any allergies?

Previous Details

Have you previously lived at another UK address? *
Please include postcode.
Have you been previously registered with another surgery in the UK? *

If you are from abroad

Are you registering for the first time in the UK? *
Please use this date format: DD/MM/YYYY.
If you are under 3 years old you must have a named health visitor. If you do not have one please call the health visitors on 0121 466 4820.

If you are returning from abroad

Previously been a resident in the UK

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Carers

Do you have a carer?
Are you a carer for someone?
Do you give us permission to discuss your medical record with your carer?