New Patient Registration

If you would like to register with the practice please complete this online form.

We welcome all new patients to Humberstone Medical Centre from the following areas: Humberstone, Hamilton, Evington, Scraptoft, Crown Hills, Rowlatts Hill, Netherhall, Goodwood, Thurnby Lodge, Thurnby, Northfields/Gipsy Lane. If you are outside these practice areas please contact us as we also have some patients in neighbouring areas.

Patients will, in future be registered with the practice and not with an individual GP.
The practice offers new patients over the age of forty an appointment for a
Health Check with one of our Health Care Assistants.

When registering new patients the Practice does not discriminate on any
grounds.

Please note: Once you have completed the form you will need to come into the practice with proof of identity to complete your registration.

New Patient Registration

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Gender *
Can we contact you by text?
Can we contact you by email?

Ethnicity

Please specify the ethnic group you consider you belong to:
Do you speak English?
Do you read English?

Emergency Contact

Are they your Next of Kin?
Do you give us permission to discuss your medical records with them?

Allergies

Do you have any allergies?

Previous Details

Please include postcode.

If you are from abroad

Registering for the first time in the UK

Please use this date format: DD/MM/YYYY.

If you are returning from abroad

Previously been a resident in the UK

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.

Carers

Do you have a carer?
Are you a carer for someone?
Do you give us permission to discuss your medical record with your carer?