New Patient Online Registration
Registering online is for new patients only and takes 5-10 minutes.
Have you been registered with a GP in the UK before? *
Type N/A in the box if you do not have a previous GP.
Next of Kin Contact Details
Do you have any of the following medical problems (tick all that apply):
High Blood Pressure
Previous Heart Attack
Mental Health Illness
Please include medication name, doses and frequency.
Please include medication , food and other allergies.
Height/Weight (Please estimate if unknown)
Sexual Health (Female)
Are you currently pregnant?
Would you like support to quit smoking ?
Please estimate units or use unit calculator:
Are you a carer?
Do you have a carer?
Would you like to be added to our carer's register?
Organ Donation - Optional
I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death. Please tick the boxes that apply.
Any part of my body
I do not wish to register
Upload Proof of ID
Proof of ID is strongly recommended. However, Willesden Green Surgery is an inclusive practice, and we will not refuse to register a patient if he/she is unable to provide proof of ID.
Would you like to receive important text messages (including appointment reminder) from the surgery? * Recommended
Would you like to receive important email information from the surgery? *
I have read and checked the above information, and confirm it is correct.
Please ensure all compulsory boxes (marked with *) are complete.