New Patient Registration

Our team are very experienced in establishing your official National Health registration. You are now registered with our practice and not an individual GP. However, as a patient registered with the practice, you have the right to ask for an appointment with the GP of your choice. You will be asked to complete a registration form.

All newly registered patients are asked to fill in a questionnaire. WE ONLY ACCEPT PATIENTS FROM WITHIN OUR PRACTICE BOUNDARY. 

Please note that this application form is for the practice based in North Ayrshire.

Personal Details

If ‘No’, please complete a temporary resident form instead

# the data supplied in these fields will not be input to, or updated in, the Community Health Index (CHI), but will be held on the GP Practice’s system.

The following information can be found on your current medical card:

The following information can be found on your birth certificate:

Help us to trace your previous GP health records by providing the following Information
If you are from abroad:
If you have served in the British Armed Forces
Voluntary authorisation for organ or tissue donation

I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my death. Your consent to organ donation will be shared with NHS Blood and Transplant together with the

For more information on being an organ donor or privacy, please ask for the leaflet on joining the NHS Organ Donor Register or visit www.organdonationscotland.org

Notes on tissue – Heart valves and corneas come under the ‘heart’ and ‘eyes’ boxes respectively so the ‘tissue’ box covers donating other types of tissue, such as your tendons.

How we use 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

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.

Official Use Only

This section is for the practice administrators only, we would ask patients not to enter any information in the fields below


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.


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