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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).

1Beechwood Medical Centre Registration Form

2Are you from abroad?

3Are you returning from the Armed Forces?

4If you are registering a child under 5

5If you need your doctor to dispense medicines and appliances*

* Not all doctors are authorised to dispense medicines

6About You

7Lifestyle

If you are interested in help to stop smoking, please book in at reception for the Smoking Cessation Clinic

8Alcohol

9NHS Organ Donor registration

10NHS Blood Donor registration

Please include the postcode

11PATIENT DECLARATION for all patients who are not ordinarily resident in the UK

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice,

Select one of the following options:

Declaration:

A parent/guardian should complete the form on behalf of a child under 16.

12Complete 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.

13NON-UK EUROPEAN HEALTH INSURANCE CARD (EHIC), PROVISIONAL REPLACEMENT CERTIFICATE (PRC) DETAILS and S1 FORMS

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

If yes, please enter details from your EHIC or PRC below:

PRC validity period

How will your EHIC/PRC/S1 data be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

14Accessible Information

15Important 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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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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Beechwood Medical Centre, 60a Keighley Road, Ovenden, Halifax, HX2 8AL
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Your Neighbourhood Professionals. Just a Click Away! New Crossleys Cars Private Hire
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