Carrfield Medical Centre
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Providing NHS services

What is the name of the person you are registering?

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Please enter their first name
Please enter their last name

What is your relation to the person you are registering?

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How can we contact the applicant?

Please enter a valid email address
Please enter a valid phone number
We'll use these details to update them on the status of your application.
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What is the applicant's address?

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What is the applicant's sex as recorded on their NHS record?

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What is the applicant's ethnic group?

or
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What is the applicant's date of birth?

For example, 15 3 1984.
Please enter a valid date of birth as DD MM YYYY
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Has the applicant registered with a GP before?

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Has the applicant recently moved from abroad?

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Are they on any repeat medications?

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Finally, please confirm the applicant's details are correct

Personal details

Email address Edit
Phone number Edit
Gender Edit
Ethnicity , Edit
Date of birth
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