Registering online is for new patients only and takes 5-10 minutes.
Please type N/A if born in the UK.
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?
Are you a carer?
Do you have a carer?
Would you like to be added to our carer's register?
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.