New Patient Registration Form

Please complete this registration form ensuring all required fields are completed. Submitting this form will register you with The Manor Surgery in Beeston, Nottingham.

Before registering with the surgery, please ensure that you are living within the surgery's catchment area by clicking here.

Please note that if you are trying to register a new born baby, the forms will need to be collected from the surgery. 

If this is your first time registering with an NHS GP Practice, you will need to fill in a GMS1 form. This form can be collected from the surgery.

If you have any issues with your registration please contact the surgery directly.

Last Updated: 02/03/2023

Patient Details

Please check that all data is correct and spellings are accurate as this will affect your registration.

Current Home Address

Please be aware that we can only register patients who live within our catchment area. If you are unsure whether you live in our catchment area please contact the surgery.

Contact Details

Please provide us with at least one contact number and ensure these are correct and up to date. Failure to do so will halt your registration.

Next of Kin

Please include a contact number for your next of kin. They do not need to be a relative.

Previous GP Practice

In order to obtain your medical records from your previous GP please provide the following information:

Additional Information

Nominated Pharmacy

The majority of prescriptions are now sent electronically to a pharmacy. Please provide the name of a local pharmacy you would like us to send any future prescriptions.

SMS – Text Messaging Service

We are able to contact you by SMS for appointment confirmation/reminders/cancellations and Health Promotion Invitations.

Patient Health Questionnaire

Please answer the following questions about your health

Smoking Status

Please answer the following question regarding your smoker status. 

Alcohol Intake

Please be advised that 1 unit = 1 small glass of wine or 1 single measure of spirit or half pint of normal strength beer


Are you providing much-needed care to a family member or friend? You are a carer if you provide unpaid support to a family member or friend. They may need support because they are ill, frail, disabled, or have mental health or substance misuse problems. If you have answered yes please ask reception for a Carers Information Pack

Support for Dealing with Homelessness

The Practice offers support for people who are homeless. 

Support for Asylum Seekers

The Practice offers support for assylum seekers. 

Summary Care Record (SCR)

If you are registered with a GP practice in England, you will already have a summary care record (SCR), unless you have previously chosen not to have one. It will contain key information about the medicines you are taking, allergies you suffer from and any adverse reactions to medicines you have had in the past. Information about your health care may not be routinely shared across different healthcare organisations and systems. You may need to be treated by health and care professionals who do not know your medical history. Essential details about your healthcare can be difficult to remember, particularly when you are unwell or have complex care needs. Having a Summary Care Record can help by providing healthcare staff treating you with vital information from your health record. This will help the staff involved in your care make better and safer decisions about how best to treat you. You have a choice of what information you would like to share and with whom. Authorised healthcare staff can only view your SCR with your permission. The information shared will solely be use for the benefit of your care. Your options are outlined below Expressed consent for medication, allergies, adverse reactions and additional information. You wish to share information about medication, allergies for adverse reactions and further medical information that includes: your illnesses and health problems, operations and vaccinations you have had in the past, how you would like to be treated (such as where you would prefer to receive care), what support you might need and who should be contacted for more information about you. OR Express distant for summary care record (opt out). Select this option if you do not want any information shared with other healthcare professionals involved in your care.

EDSM- Enhanced data sharing model

The EDSM allows your GP to share your record with other healthcare providers. This will help to deliver better and safer care for you.

Online services

We offer an online service through the NHS app. With this service you can order your repeat prescriptions online, book appointments and view your medical records. You can sign up for this service directly through the NHS app. Simply download the NHS app from the app store on your smart phone or tablet and follow the in app instructions. If you require any additional support please follow the NHS app links on our website or contact the surgery direct. Please note that you will have to provide ID to access these online services.

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