Adult Registration Form (16+)
Important Information:
Please ensure you have written your NHS number on the registration form; we require this number to register you at Moorside Surgery.
How to Obtain your NHS Number: You can obtain your NHS number via the NHS App, looking at a previous prescription or hospital letter or phoning your previous GP surgery. You can also find your NHS number here
If you do not include your NHS number this could cause a delay in the registration process.
Newborn Babies NHS Number: newborn babies NHS number will be on the discharge summary and in the 'red book'.
Registration Protocol
You will need to complete a Registration form (GMS1). New Patient Health Questionnaire and Ethnicity Form and a leaflet describing the Summary Care Records project - with your consent we are able to share some very basic medical details with other NHS organisations that may be involved in your care. This will help us treat you appropriately whilst we wait for your records to be sent by WYCSA (this usually takes about 6 weeks)
In accordance with recommendations made by the NHS Counter Fraud and Security Management Service the following details are required from all persons wishing to register at this Surgery please provide us with (1) Document from section A and (1) Document from section B.
Documents accepted to confirm identity: A |
Documents confirmed to confirm address: B |
Birth Certificate: UK Citizen |
Current UK Photo card driving licence (full or provisional) with current address |
Current fully signed Pssport (if from a Non-EU Country Passport and Visa) Visa should be longer than 6 months |
Current UK driving licence - paper style (full) with current address |
Current UK Photo card driving licence (Full or Provisional). With current address. UK Citizen. |
Recent utility bill e.g. Gas, Electric and Land Line Telephone - Less than 3 months old |
Current EEA member state ID card EU Passport Photo ID plus birth certificates for children. If possible. |
Recent Bank / Building Society / Mortgage Statement - less than 3 months old |
Current residence permit |
Current Council Tax Bill - less than 3 months old |
Benefit/Pensions book (card not acceptable) |
Benefit / Pensions book (Card not acceptable) |
Official tax notification from Revenue and Customs: PAYE Coding Notice Tax Assessment Statement of Account |
Official tax notification from Revenue and Customs: PAYE Coding Notice Tax Assessment Statement of Account |
Please help us trace your previous medical records by providing the following information
Were you ever registered with an Armed Forces GP
PATIENT DECLARATION for all patients who are not ordinarily resident in the UK
NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS
New Patient Questionnaire
Patient Choices regarding sharing of health records
Online Medical Records Access
Summary Care Record - Your Emergency Care Summary
Proof of ID and Residential Address
Privacy Protection
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
Learn more about our Privacy Policy and
Terms of Use.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.