New Patients

Welcome to Maida Vale Medical Centre!

We are happy to register new NHS patients within our practice boundary area.

If you would like to register as a patient with our Practice please:

  • 1 – Complete both forms (GMS1 and New Patient Health Questionnaire) and have the relevant documents required
  • 2 – Send a copy of the documents to the Practice via post or email to clccg.admin-mvmc@nhs.net
  • 3 – A health care professional will call you for a new patient health check when your registration has been processed.

Forms to be completed: 

A) GMS1 Form

Click here to fill 
NHSFamily doctor services registrationGMS1

Patient's Details

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

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

If you are from abroad

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

If you are returning from the armed forces

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

If you are registering a child under 5

If you need your doctor to dispense medicines and appliances*

*Not all doctors are authorised to dispence medicines

NHS Organ Donor registration

For more information, please ask at reception for an information leaflet or visit the website www.uktransplant.org.uk, or call 0300 123 23 23.

NHS Blood Donor registration

For more information, please ask for the leaflet on joining the NHS Blood Donor Register

Supplementary Questions

Ordinarily Resident

Anybody in England can register with a GP practice and receive free medical care from that practice.

However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.

Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.

More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. Alternatively for more information go to www.nhs.uk/visitingengland.

You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.

The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.

I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate
action may be taken against me.

A parent/guardian should complete the form on behalf of a child under 16.

European Economic Area (EEA) Country

For a list of EEA countries visit: www.gov.uk/eu-eea
For more information about the European Health Insurance Care (EHIC), visit: www.nhs.uk/ehic.

If you are visiting from another EEA country and do not hold a current EHIC (or Provisional Replacement Certificate (PRC))/S1, you may be billed for the cost of any treatment received outside of the GP practice, including at a hospital.

EHIC/PRC

Please enter the details from your EHIC or PRC below.

S1 Form

Please give your S1 form to the practice staff.

How will your EHIC/PRC/S1 data be used?

By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.

Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.

B) New Patient Registration Questionnaire (please pick the relevant one according to age Adult or Child)

Copy of documents to be sent to the Practice with the two completed forms above :

Please send two forms of identification from the list below, one must be a photo ID and one must show your current address:

  • Photo proof of ID – e.g. Passport, Photo Driving License or Photo ID card
  • Birth Certificate for new born babies (and any child that do not have passport issued)
  • If possible, your Immunisation Records – usually the Personal Child Health Record (“Red Book”)
  • If relevant, your Repeat Medication Request Slip from your previous GP
  • Proof of Address – Must be in your name and dated within the past 3 months – Provided in one of the following: Bank statement, Utility Bill (Gas, Electricity, Water), Council Tax, Tenancy Agreement or Landline Phone Bill (Mobile phone bills are not accepted)

*Your full registration will commence only when Part 1 & Part 2 are completed.