New Patient Registration

Complete your details below

Register as a new patient

Once you have completed the online registration form, please visit the practice with a photographic ID, proof of your address and to sign your GSM1 form.

All new patients are offered a new patient health check with the HCA, so please speak with a member of the reception team who will arrange this for you.

The registration process normally takes 48 hours, if during this time you need medical advice, please visit your previous surgery, contact NHS 111, visit your local pharmacy or for urgent medical advice call 999.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Date of Birth*
DD slash MM slash YYYY
Gender*
As with everything on this form, your details will be kept strictly confidential.
- Male
- Female
- Neutral
- Rather not say
Do you know your NHS number?*
- Yes
- No
NHS Number*
Do you know the address of your last doctor?*
- Yes
- No
Were you born in the United Kingdom?*
- Yes
- No
What is your country of birth?*
When did you first come to the United Kingdom?*
MM slash DD slash YYYY
Address of your most recent doctor (GP surgery)
Address Line 1 Address Line 2 City County Post Code Country
You may use this space for any brief additional comments
Your data*
We take your privacy seriously and will only use your personal information to provide you the services you have requested from us. Your data will never be shared with third parties. However, from time to time, we would like to contact you with details of other services we offer. If you consent to us contacting you for this purpose please select below how you would like us to contact you.
- Email
- Mail
- Telephone
- Do not contact me about other services
Phone
This field is for validation purposes and should be left unchanged.

SURGERY ENQURIES

020 8689 7800 - lines open 8.30am
swlccg.brigstockfamilypractice@nhs.net
Brigstock Family Practice 83 Brigstock Road Thornton Heath Surrey CR7 7JH

SURGERY HOURS

Monday - Friday*	08:00 - 20:00
Saturday**	09:00 - 17:00

*Surgery reception closed between 1pm-2pm every Weds for training

**North Croydon GP Enhanced Access & Reception Service only

REGISTER AS PATIENT

PRACTICE BROCHURE

Download

HOW WAS YOUR EXPERIENCE WITH US?

USEFUL CONTACTS

General enquires & appointments (from 8.30am): 020 8689 7800

Brigstock Skin and Laser Centre 0330 555 6060

NHS Croydon: 020 8274 6000

Patient advice and liaison service (PALS): 020 8274 6333

Public Health Department: 020 8274 6239

Croydon Intermediate Ear Nose and Throat service 020 8683 6734

NHS Out of hours service 111

Data Protection Officer Umar Sabat | Email: dpo.swl@nhs.net