New Patient Registration Form

Please complete this online registration form. The information will allow the surgery to complete the government required Family Doctor Services Registration Form (GMS1) on your behalf.

Last Updated: 04/08/2020

Your Contact Details

Information About You

Previous GP

Medical Information

Choice of pharmacy


NHS Organ and Blood Donor Registration, Individual Health Record and Living Wills

To become an organ donor in Wales you can register a decision on the NHS Organ Donor Register by ticking the relevant boxes below, or choose to do nothing. By doing nothing you will be considered as having no objection to organ donation and your consent may be deemed to be given. If you do not want to become an organ donor you can register this decision on the Organ Donor Register. You can do this by going to the website or calling the phone number below. It is not possible to offer the facility to opt out via this form at the present time. or call 0300 123 23 23



Family History

Next of Kin

Contacting You

Signature and consent

I declare to the best of my belief this information is correct. By electronically signing below I am consenting to: the choices made in the NHS organ donor register section; the NHS blood donor register if you have selected that preference; and to the Family Doctor Services Registration Form (GMS1) being completed and signed on my behalf by the surgery.