Temporary Registration

The form is for temporary registration only. If you wish to register with us permanently you will need to use the new patient registration form (click here)

How long do you wish to register with Greyfriars SurgeryIf you wish to register with us permanently you will need to use the new patient registration form

Title

First names

Surnames

Previous surnames

Date of Birth

Gender

Town and country of birth

NHS Number

Address

Home Telephone

Work Telephone

Mobile Telephone

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

Your previous address in UK

Name of previous GP practice while at that address

Address of previous GP practice

If you are from abroad

Your first UK address where registered with a GP

If previously resident in UK, date of leaving

Date you first came to live in UK

Were you ever registered with an Armed Forces GP

Please indicate if you have served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas:

Address before enlisting

Service or Personnel number

Enlistment date

Discharge date (if applicable)

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Greyfriars Surgery • South Square, Boston, Lincolnshire , PE21 6JU.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Key Information

Temporary Registration

Privacy Protection