Almond Group Practice

The Glebe, Kirkliston & Niddry Road, Winchburgh

Temporary Registration < 3 months for PRINTING

How to Register:

1. Check that you are temporarily living within our practice boundary.

2. Identification. This is no longer needed to register with a practice. If deemed necessary however, we are able to ask for identification at any point to confirm your identity and your address for reasons of data protection and practice boundaries.

3. Complete the Registration form below. We will notify you once you are registered.

Registration (Temporary Resident) – PRINTABLE WITH ID

PERSONAL DETAILS

Please confirm you will be here for less than 3 months. (If not, please complete the normal registration form)
Have you ever been a patient at this practice in the past?
Sex at Birth
Please include any flat, floor and block number or name in your address details.
Please include any flat, floor and block number or name in your address details.
If you don’t have a mobile number, please state ‘none’. However, we cannot register you without a mobile or landline number
Does the mobile number belong to the patient?
Please state your name and relationship to the patient

Current GP

Are you registered with a GP in the UK?

MEDICAL HISTORY

Allergies to Medication – Do you have any?

Medical History

HOW THE NHS USES 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. Read more using the link below.

“How the NHS handles your personal health information”

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, relevant information from this form will be disclosed to the NHS Business Services Authority, NHS National Services Scotland, the Home Office, Identity and Passport Service, HM Revenue and Customs, The General Register Office and Local Authorities.

I am temporarily away from my normal/permanent residence for period indicated above.  I understand that I cannot register with any other GP practice whilst attending this practice and that I am also not allowed to attend or obtain treatment/prescriptions from my usual practice at the same time as being registered temporarily here.  I understand that checks may be made with my registered practice or NHS National Services Scotland to confirm my eligibility to lawfully register with this practice temporarily and for the purposes of receiving medical care/medication.

Are you the patient or a representative of the patient?

We use your information to provide healthcare and update your medical record. We may share relevant information with NHS services involved in your care. For full details, please see our Privacy policy.

Consent