New Patient Registration Form

Please complete the below New Patient Registration Form. Please do not click the submit button more than once. It may take a few seconds to submit the information.

It takes up to 10 working days to process your registration. To avoid delays, please provide all the information requested – otherwise our admin team will have to contact you for queries or missing information – together with all up-to-date contact details.

If you are registering because you want the Covid vaccine, please note it can take 6 weeks for NHS England to recognise you have registered and for you to become eligible for the vaccine: we are unable to expedite your registration at our end because NHS England is receiving a very high volume of registrations.

We understand any frustration and thank you for your patience.

Once your registration is complete, you will become a registered patient at Clerkenwell Medical Practice and will be able to access our full range of services that include completing a website eConsult for the doctor, booking an appointment with a member of our team and requesting your repeat medication. Please note: should you have an urgent health issue that really cannot wait and you believe needs to be dealt with urgently, please contact a member of our admin team who will be able to help if your registration is still being processed.

NHS        GMS1 and New Patient Registration Form

Patient's Details

Please use this date format: DD/MM/YYYY.
If known.
Where applicable, if known.
Please ensure that your email address is correct.

Next of Kin Details


Please help us trace your previous medical records by providing the following information

If you are from abroad

Please use this date format: DD/MM/YYYY.

If you need your doctor to dispense medicines and appliances

Not all doctors are authorised to dispence medicines

NHS Organ Donor registration

For more information on organ donation please visit:

NHS Blood Donor registration

For more information, please ask for the leaflet on joining the NHS Blood Donor Register