Temporary Patient Registration

If you are ill while away from home and need to see a Doctor in Ware, please use this form. You can then contact us to discuss your medical concern.

You can be registered as a temporary patient for up to three months. This will allow you to be on our Practice list and yet still remain a patient of your permanent GP. After three months you will have to re-register as a temporary patient or permanently register with our Practice.

Temporary Patient Registration

Temporary Patient Registration

Patient's Details

Title *
Please use this date format: DD/MM/YYYY.
Please let us know your preferred contact number in case we need to contact you.
Any responses we send will go to this email address.
How long do you need to be registered at the practice for? *

Temporary Address Details

Home Address Details

Information about you

Do you need an interpreter? *
Ethnic Group *

Details of treatment should be sent to:

To be completed by the doctor:

Emergency treatment:
Temporary resident:
Contraceptive services:
Dental haemorrhage:

I declare to the best of my belief this information is correct and I claim the appropriate payment as in the SFA. An audit trail is available at the practice for inspection by the HA’s authorised officers and auditors appointed by the Audit Commission.