Providing NHS Services

Churchill Medical Centre

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Temporary Patient Registration

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All questions marked with a * are mandatory

If you are currently staying within our practice boundary and need urgent medical care

Please contact your registered GP in the first instance to see whether they can continue to support you remotely e.g. by sending a prescription for your medication to one of our local pharmacies.
In most other cases, calling 111 is a better option.
If you need to see a doctor, you can register at the practice as a temporary resident by completing this form.

Find out more about the process by visiting the NHS Website

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Patient Details

Title: *

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources.

Do you have a temporary address?: *

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Your Usual Doctors Details

All details of treatment will be sent to this doctor and address.

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This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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