New Patient Registration

If you need any support completing these forms please ask our reception teams who will be happy to help you. Please ensure you complete the Purple GMS (General Medical services) form clearly at the front of this leaflet. You can obtain your NHS number from your previous GP surgery. We do understand that not all questions on our registration forms are applicable to all patients. However it is important we use the registration process to capture as much information as possible. This is to ensure that we are offering you the best standard of care and can signpost patients who may need extra support at the point of registration. Please complete the registration forms to the best of your knowledge with as much information as possible.

Last Updated: 11/12/2020

Personal Details

Online Services

We recommend that patients provide identification when registering at the practice. If you’re unable to provide identification we can still register you. However you won’t be able to access our online services without proof of identification. We do recommend patients sign up for online services. If you have previously been de-registered under our zero-tolerance scheme you must not register with our practice, without first writing to the Practice Manager with your request. If the practice declines your request to register they will inform you in writing of the decision. The practice has a right to remove your registration at their discretion at any time if you have previously been removed from our list for abusive behavior and not informed them at the point of re-registering.

Contact Details

Next of Kin

Other Required Details

Summary Care Record & Third Party Access

Your records will automatically be coded for an Enhanced summary Care record . If you do not want a summary care record, please request OPT out form. Your Summary Care Record is a short summary of your GP medical records. It tells other health and care staff who care for you about the medicines you take and your allergies. It means they can give you better care if you need health care away from your usual doctor's surgery: for example, in an emergency, when you're on holiday, when your surgery is closed, at out-patient clinics or when you visit a pharmacy. In the Practice we aim to provide you with the highest quality of healthcare. To do this we must keep records about you, your health and the care we have provided or plan to provide to you. Everyone working for the NHS has a legal duty to keep information about you confidential. If you would like a family member or carer to have access to your medical records on your behalf. We need to keep their contact details on your records. The person you nominate must be happy to have their details recorded in your medical records. If you wish to nominate someone for this reason please provide us with their details and sign below that you consent to this

Language & Ethnicity


Personal Medical History

Family History


If you are taking regular medication from your previous GP you will need to book an appointment before our G.P’s can issue this, please allow yourself plenty of time so you do not run out of medication and bring along any previous prescription requests / medication with you to the appointment. Please note we do not accept prescription requests over the phone unless you are housebound and prescriptions take 48-72 hours to be processed.



Women only



We want to make sure you can read and understand the information we send you. If you find it hard to read letters or if you need someone to support you at appointments, please let us know in the answers given below


I acknowledge that appointment reminders by text and/or email are an additional service and that these may not take place on all/or on any occasion and that the responsibility of attending appointments or cancelling them still rests with me. I can cancel the text and/or email message facility at any time. Text messages are generated using a secure facility however I understand that they are sent over a public network onto a personal telephone and as such may not be secure, however the practice will not transmit any information which would enable an individual patient to be indentified. I agree to advise the practice if my email address changes and also if my mobile telephone number changes or if this is no longer in my possession. The practice does not share mobile phone contact details or email addresses with any external non-NHS organisation. Your medical records may be used for financial or clinical audit, post payment verification checks, medical research or education purposes.


If you are homeless or at risk of homelessness please complete the information below. The reason we ask for this information is so that we can send a referral to the local homelessness team

Practice Boundary

You can only register at our practice if you live within the catchment area for our practice. Please only submit your registration if you live within the areas below – IF you have completed this form and do not live in our boundary area you can take this form to any surgery in Milton Keynes close to your home address

Thank you for your registration

Please now scan and send us copies of your proof of address and identification valid in the last 3 months. Please send this to our secure e-mail . We will then process your registration. Please allow 3 - 5 Working days until you are registered with Hilltops Medical Centre.