Beechwood Medical Centre Registration Form
Caring About Quality
Please complete where indicated or tick the appropriate box as required
Once you have completed the online form, to complete your registration with the practice you will need to come in to the surgery with photographic ID (e.g. passport or driving licence) and proof of address (e.g. recent utility bill or bank statement).
Beechwood Medical Centre Registration Form
Are you from abroad?
Are you returning from the Armed Forces?
If you are registering a child under 5
If you need your doctor to dispense medicines and appliances*
About You
Lifestyle
Alcohol
NHS Organ Donor registration
NHS Blood Donor registration
Please include the postcode
PATIENT DECLARATION for all patients who are not ordinarily resident in the UK
Complete this section if you live in another EEA country, or have moved to the UK to study or retire, or if you live in the UK but work in another EEA member state. Do not complete this section if you have an EHIC issued by the UK.
NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS
Accessible Information
Important Information About The Registration Process
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.