GP Secure Online Forms

Kilbirnie Medical Practice New Patient Registration

Kilbirnie Medical Practice NPR with Extra Questions

When you want to register with a new GP practice, you’ll need to complete these details to ensure that your new GP practice has all your medical history and your medical records.

If this is your first registration with a GP practice in the UK, medical records from outwith the United Kingdom won’t be traced.

You can only register with a GP practice if you’re staying in the area for more than 3 months. If you’re not, you may still be treated, but as a Temporary Resident.

Do not complete this form for Temporary Resident registration — please contact the practice directly for Temporary Registration.

Will you be in the area for more than 3 months? *
If you will not be in the area for more than 3 months please contact the practice directly to register as a temporary resident.
Sending

Please note that we will not respond to any medical information or questions received via this form.

The information you supply us will be used lawfully, in accordance with the Data Protection legislation and GDPR.

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 communicating with the practice.

Are my details secure?

The internet is not a secure place, however, we have gone to great lengths to make sure the information you submit to us is as secure as possible.

This website runs within a secured connection (256-bit SSL). So any information entered into the system is transmitted in encrypted form (you will see the little lock symbol in your browser address bar to confirm this). Details are transferred to your practice via a TLS-encrypted connection to the NHS email system.

Other Notes:

All fields marked with * are mandatory.

Kilbirnie Medical Practice

Kilbirnie Health Centre
2-4 Kirkland Road
Kilbirnie
KA25 6HS
Telephone: 01505 683591