Application to Register with a General Medical Practitioner - GPR (Scotland)

Fields marked REQUIRED are compulsory. You should only send this form if you believe that you are eligible to join this practice. Sending this form will NOT automatically register you with the surgery. Your details will be kept at the surgery. Sending this form does NOT guarantee or even imply that you will be accepted onto the practice register.

1. Personal Details

Is this your first registration with a GP Practice in the UK? *

Yes No

Will you be in the area for more than 3 months? - If 'no' please complete a temporary resident form" *

Yes No

Sex

Female

Male

Other

Date of Birth *

Surname *

First name(s) *

Previous Surname

Marital Status

Home address *

Postcode *

Telephone

Mobile *

Email *

Community Health Index - CHI (can be found on your current medical card)

NHS number (can be found on your current medical card)

Town of birth (can be found on your birth certificate) *

Country of birth (can be found on your birth certificate) *

Reg. district of birth (can be found on your birth certificate)

Mother's maiden name (can be found on your birth certificate)

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

Address in UK when last registered with a GP (if applicable, N/A if not) *

Postcode (if applicable, N/A if not) *

Name and address of previous GP practice in UK (if applicable, N/A if not) *

Postcode

If you are from abroad

Date you first came to live in the UK

If returning from abroad, date of departure from UK

Your most recent country of residence

If you have served in the British Armed Forces

Enlistment date

Service Number

Are you a reservist?

Yes No

If yes, please provide your address before enlisting

Postcode

Leaving date

Is this your first registration with a GP since leaving the armed forces?

Yes No

Voluntary consent to organ donation

You have a choice about organ or tissue donation after your death. To find out more about why it is important that you take the time to make your donation decision and record it, go to www.organdonationscotland.org

How we use your information

The information you have provided will be used by NHS Scotland to carry out its various functions and services including scheduling appointments, ordering tests, hospital referrals and sending correspondence.

Your information, including your name, gender, date of birth and address, will be passed to NHS National Services Scotland where it will be held on the Community Health Index (CHI). This information is used to register you with the GP Practice, transfer your medical records between GP practices in the UK, make payments to GP Practices for medical services provided, and to process and issue medical exemption certificates and entitlement cards.

NHS National Services Scotland shares information about you within NHSScotland to assist in the provision and improvement of NHS services and the health of the public. When we do this, we do it as described by NHS Scotland in the NHS Inform website under the “How the NHS handles your personal health information” section.

NHS Scotland is made up of various organisations such as NHS Health Boards, GP practices, the Scottish Ambulance Service or NHS National Services Scotland (the common name of the Common Services Agency for the Scottish Health Service). These organisations are individually responsible for your personal health information. In terms of data protection and privacy laws, they are known as ‘data controllers’.

Find out more about NHS Scotland in the link provided above

Patient Declaration

I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, the minimum necessary information from this form could be disclosed to relevant authorities.

I understand that more comprehensive information about how NHS Scotland handles my data is available from NHS Inform.

This information can be provided in other languages and formats on request. The NHS Inform helpline provides an interpreting service.

Patient's / Patient's representative signature/name (please type): *

Date *

Relationship to patient (if applicable)

Additional Registration Information

The above data is passed to appropriate authorities to formally register you with our practice and transfer your registration from your previous practice.

It is very helpful to us to also collect additional medical information to help us provide care if needed while we await the transfer of your previous medical records, which can sometimes take some months.

Thank you for answering the following additional questions.

Next of Kin: name *

Next of Kin: Address *

Next of Kin: Contact number *

Medical History: please record any serious illnesses or operations and the year in which they occurred. *

Allergies: Please record any serious allergies or sensitivities to medications or other substances *

Medication taken (please detail name, dose and frequency). If available, please submit a copy of your repeat medication slip from your last GP with your registration documents. *

Preferred Pharmacy (where we will send any prescriptions you require) *

Argyll Pharmacy

Truhealth Pharmacy

Are you a current smoker? *

Yes No

Have you ever smoked in the past? *

Yes No

Number of cigarettes per day *

Number of years smoking regularly *

Carers

Are you a carer for a child with additional needs or another adult?

Yes No

If yes, please give details

Do you have a carer to help you with day-to-day tasks? (this could be a relative who also helps care for you)

Yes No

If yes, please give details

Ethnicity

Alongside all Scottish public services, we are committed to ensuring that our services are provided without bias and take monitoring of ethnicity data seriously.

Alcohol Use

We know that taking too much alcohol can be harmful to your health. We are here to help if alcohol use may be causing harm to your health.

Each of these is ONE unit of alcohol:

1/2 pint of beer, lager or cider

1/2 glass of wine

1 measure of spirits

Each of these is MORE THAN one unit of alcohol:

1 pint of regular beer/lager/cider- 2 units

1 pint of premium beer/lager/cider- 3 units

1 bottle of regular lager- 1.5 units

1 can of premium lager or strong beer- 2 units

1 can of super strength lager- 4 units

1 glass of wine- 2 units

1 bottle of wine- 9 units

Practice communications

Our practice prefer to contact patients by SMS text message to ensure rapid communication and to save on postage costs for short messages.

These communications might include: requests to call the practice to make a routine disease monitoring appointment; requests to call the practice to discuss bloods tests; notifications that a prescription for a new medicine is available; notifications about important service changes.

Please indicate if you are happy to receive communications by text message.

I am happy to receive essential communications from the practice by text message *

Yes No

Online Patient Services

If you are over 16 years of age we offer an online service for requesting repeat prescriptions using the Patient Services link from our website.

If you would like to use this service, we require that you also attend the practice to confirm your identity by providing a Passport, Driving License or Birth Certificate. Once you are formally registered with the practice, we will send you the information that will enable you to create a username and password to access this service.

Request your repeat prescriptions online

Request your repeat prescriptions quickly online by logging into your account and simply ticking the appropriate boxes. You can review the progress of your repeat prescriptions and any message that the practice may have sent to you.

I would like to register for Online Patient Services *

Yes No

Privacy and security

Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration. Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Page last reviewed: 16 April 2026
Page created: 23 March 2026

Cookies on the Lochgilphead Medical Centre website

Application to Register with a General Medical Practitioner - GPR (Scotland)

Application to Register with a General Medical Practitioner - GPR (Scotland)

Further Information