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Noticeboard

Registration Form


Please ensure you write down your NHS number on the form


Thank you


 


Flurflen Cofrestru


A wnewch chi sicrhau


Eich body n ysgrifennu


Mewn rhif GIG ar y fflurflen


Diolch


                                


 

New Patient Registration

PreRegistrationIf you wish to register click on the link below to open the form. When you have completed all of the details, print the form and sign and date where appropriate. Please ensure you enter your NHS number. When you visit the surgery our receptionist will check that all fields have been completed correctly and that the form has been signed.

You will also need to complete our medical questionnaire. This is because it can take considerable time for us to receive your medical records.

If you do not have access to a printer, you can register by dropping by the surgery.

 


pdfGP registration form - Download and save to your computer. You can tick and fill in most fields on your computer before printing, but you must remember to sign and date after printing. We will not accept forms that have not been signed under all relevant fields.

Holiadur i gleifion newydd

 

New patient health questionaire

 

pdfHoliadur Plant

pdfChildrens Questionnaire

 

 

 

 
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