University of Lincoln Health Service

Registration for the University of Nottingham Health Service

Please fill in your details and click Submit when complete. * = compulsory

Please only complete this registration form once. If you have previously submitted this form
at any time please do not do so again unless advised by the Health Service to do so.

Please do not use this form to update your address or other details. Use THIS FORM instead
to update your address or other details if you are already registered with us.

Study course at university
Approximate length of course
* Title:       
Please enter all your first names in full
 If you don't know your NHS number it's very important that you fill in part 1 and 2 below
* Gender:      
For example: she/her or he/him.
Would you prefer your title to be "Mx",
instead of the title selected above?
Please enter UK Country (England, Scotland, Wales
or Nothern Ireland) if from UK., e.g. "London, England"
Nottingham Address.
If you live in student accommodation, please select your address and flat from the lists below:
Student Accommodation:
Flat/Apartment: 'Not required for Halls on campus
If you don't live in student accommodation, please enter your complete address below:
Enter your own telephone number. Preferably your mobile number

Enter your e-mail address
Confirm your e-mail address
* May we contact you using email?    
* May we contact you using SMS text?    
Please help us trace your medical records by selecting if you are a UK or International
patient (Part 1) and then filling in the next section (Part 2)
* Part 1. Select if you are from UK or abroad:
Part 2: Fill in if you come from the UK
Previous address in UK before moving here

Part 2: Fill in if you come from abroad (international patient)
Your BRP number (if you have one)
You can't register before you arrive in the UK

(only if you have previously registered with a GP)

If a previous resident in UK, the date you left: Date you left UK if you had registered with a GP before
Are you up to-date with your
childhood vaccinations?
Supplementary Questions:
Please select one of the following options: More information...
Complete the following section if you come from another EEA country: Information
Do not complete this section if you have an EHIC issued by the UK.
Do you have a non-UK EHIC or PRC?   

(e.g. if you are retiring to the UK or you have been posted here by your employer for work or you live in the UK but work in another EEA member state). Please give your S1 form to the practice staff. More information...
* Signature:
Please draw your unique signature in the box
* Do you need an interpreter?       
 cm  kg
* Are you a CARER? A carer is anyone, including children and adults who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.
If you are over 25 and you were recognised as female at birth, you are eligible for
free cervical screening and will be included in the national screening programme. 
If you are unsure about screening, please read the information in this link.
After reading, if you wish to decline cervical screening, please tick the box below.
I have read the information regarding cervical screening and have
made an informed decision to decline cervical screening at this time: 
I understand that if I change my mind, I can be included again at any time.
Organ Donor Registration
Organ donation in England has changed to an 'opt out' system. You still have a choice
about whether or not you wish to become a donor and your faith, beliefs and culture
will continue to be respected. You can record your organ donation decision on the
NHS Organ Donor Register. Tell your family and friends what you have decided.
Blood Donor Registration
If you are interested in becoming an blood donor, please click this link
to go to the blood donor registration page.
Please read our Privacy Notice.
The information you are submitting will be sent encrypted to the medical practice over the Internet, which still isn't 100% secure.
If you are worried about this you can instead obtain a form from the medical practice that can be filled in and delivered by hand.
 © CampusDoctor Ltd.