Windmill Patient Registration Form (GMS1)

Last Updated: 19/08/2022

  • Patients Details

    Date of Birth
    For example, 15 3 1984
    Identity (optional)

  • Children

    Please complete this section if you are completing this on behalf of any children

    Who has parental responsibility (optional)
    Do you have any children? (optional)

  • Please help us trace your previous medical records by providing the following

  • If you are from abroad

    If previously resident in UK, date of leaving (optional)
    For example, 15 3 1984
    Date you first came to live in UK (optional)
    For example, 15 3 1984

  • If you are returning from the armed forces

    Enlistment date (optional)
    For example, 15 3 1984

  • Complete Registration

    If you are registering a child under 5 (optional)
    If you need your doctor to dispense medicines and appliances (optional)
    Signature (optional)

  • Please ensure you have completed the separate Health Questionnaire form

    If you do not complete all the required forms we will not be able to register you as a patient. If you wish to sign up for online services, please complete the relevant form.

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