Temporary Resident

If you are in our catchment area and require urgent medical care, please complete this form to allow us to register you as a temporary patient (up to 3 months).

Temporary Resident Form

Full Name

Date of Birth

Telephone Number

Temporary Address (currently staying at) including postcode

Permanent Address including postcode

Registered GP Name

Registered GP Telephone

Registered GP Address including postcode

Length of stay

Staying less than 16 days

Staying between 16 days and 3 months

Have you been registered with us before?

Yes

No

Next of Kin Details including contact number (optional)

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Page last reviewed: 25 March 2026
Page created: 25 March 2026

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Temporary Resident

Temporary Resident

Temporary Resident Form