New Patient Registration

Personal Details

If ‘No’, please contact the practice

# 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 birth certificate:

If you are from abroad:
If you have served in the British Armed Forces:

You have a choice about organ or tissue donation after your death. To find out more about why it is important that you take the time to make your donation decision and record it, go to


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’.


This information can be provided in other languages and formats on request. The NHS Inform helpline provides an interpreting service

For Practice Use Only

Identification seen – do not take or retain photocopies

I accept this patient onto the practice list and declare that, to the best of my knowledge, this information is correct. I acknowledge that the details may be authenticated from appropriate records, and that payments generated from this patient registration will be subject to Payment Verification.

For Official Use Only
New Patient Health Questions

New patients will also need to complete the following health questions

Regular / Repeat Medication

We have a repeat prescription service and you can order your prescription in person, by telephone (0141-211 6220)or by e-mail via the Practice website. Please arrange an appointment to see a doctor before your first prescription is due in order to confirm your medication requirements and to enter them on computer. This includes the oral contraceptive pill.

Medical History
Life Style

Want To Stop Smoking? If you are a smoker and want help to stop we CAN help you. Get in touch with Smoking Cessation Team on 2322110 or contact your local community pharmacy. If you prefer to see a GP or nurse just make an appointment.

Alcohol Screening

½ Pint of beer, 1 glass of wine, 1 single spirit = 1 Unit

Please take time to answer the following questions regarding your alcohol consumption

Female Patients Only

For women aged 50 to 65 only

Record of Form Submission

We will put a copy of this form in the patients records

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.