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Apply to Register as a Patient
 

If you have moved into the practice boundary you may wish to apply to register as patient with Willerby and Swanland Surgery. You can do this by completing our Patient Application Form including a GMS1 Form - and handing this in to our Reception - one form per person seeking to register. 

You can view, complete and print the form from here (see below) - please be sure to fill in all the pages.

Additionally - please also complete the patient Medical Form which will be needed if you are accepted on our patient list.

If you are on regular medication from your current surgery - please make sure you have at least a month's supply before applying to register with us - and also that, if possible, you provide us with a current copy of your repeat prescription.

You can fill each of these form in on your computer - however you must print each form out, add your signature and bring in person with relevant proofs of address and ID.

Click here to download 

 

NEW PATIENT APPLICATION VJan2019

 

Please also download and complete the new patient medical form

 

NP MEDICAL FORM VJan2019

Please complete a full set of forms for each person asking to register - including children.

When you hand in the forms, the receptionist will check the contents but will not be able to tell you that you have been accepted - that will be reviewed by the Health Promotion officer. If there are any issues with your application he/she will advise you in due course. Please allow up to 5 days for the process to be reviewed/completed.

 

Tips when completing the form ....... 

When you provide your proofs of your identity (photo-licence/passport etc) and address (utility bill/bank statement etc) we will also be able to use these to create your on-line access account. 

 

Important - please take care when choosing to exercise your right to opt-out of information sharing (Page 2) - choosing to opt-out may mean we cannot treat you as a patient, please therefore speak to the practice for more information if you are in any way unsure.

 

Additionally, if you are on any regular medication you will need to see one of our doctor's before you can receive any prescriptions from us - so please ensure you have at least 4 weeks supply from your existing practice - and where possible please provide us with an up-to-date repeat prescription order slip.

Check you live within our practice boundary (click here to see the boundary map)