Saville Medical Group
Online Registration

This registration form should only be used by Newcastle University students.

Please fill in your details and click Submit when complete.

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 Medical Centre to do so.
Please do not use this form to update your address or other details.

Have you ever registered with this practice before?	Yes   No
Course title or department:
* Title:	Mr   Mrs   Miss   Ms
* Surname:
* First name(s):
Previous surname(s):
* Date of birth:	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916
NHS No. (if known):
* Gender:	Male   Female   Other
* Town and country of birth:
Please fill in your new ADDRESS at University or select your accommodation from the list
Accommodation:	Please select... Albion House Aldis House Barker House Bernica Halls Bowsden Court Burgess House Carlton House Camden Court Castle Court Castle Leazes City Apartments Claremont Place Claude Gibb Hall Central Link Central St James Clapham House Citygate City Quadrant Drs Residence: Royal Victoria Infirmary Eastlands Halls Easton Flats Garth Heads Glassworks Glenamara House Henderson Hall Jesmond Road Joseph Cowen Halls JSK Studios Kensington Terrace Leazes Parade Leazes Terrace Liberty Central Liberty Plaza South Liberty Quay Lovaine Halls Magnet Court Manor Bank Marris House Melbourne Apartments Metrovick House Moorfield Hall New Bridge Street New Mills House Newcastle 1 North Terrace Park Terrace Student Residence Plummer House Richardson Road: Esther Campbell Court Richardson Road: Goldsbrough Court Richardson Road: Lowdon Court Richardson Road: Owen Court Roman House Rosedale Court St. James House St. James Point St Mary’s College Stepney Yard Stephenson Building Student Castle The Bruce Building The Bar The Foundry The Grand Hotel The View (Room 1-85) The View (Room 86-174) Three Sixty Turner Court Trinity Square (Flat 1-67) Trinity Square (Flat 68-146) Trinity Square (Flat 147-207) Trinity Square (Flat 208-263) Union Square Verde Building Vita Student Windsor House Windsor Terrace: Fife House Windsor Terrace: Gurney House Windsor Terrace: Hodgkin House Winn Studios
* Room/Flat/Studio:
* Street:
Area:
* Town:
* Postcode:
	You can check that you live within the catchment area of the Saville Medical Group by entering your postcode on this page...
* Mobile telephone number:
Please tick this box if you do NOT want us to use SMS (text) or email to contact you or send you reminders:
Please help us trace your medical records by selecting if you are a UK or International student (Part 1) and then filling in the next section (Part 2)
* Part 1. Select if you are from UK or abroad:	UK Student International Student
Part 2: Fill in if you come from the UK * Previous Address in UK: (i.e. last address before going to university) * Town: * Postcode: * Name of Doctor or Surgery when at that address: * Address of Doctor or Surgery: Postcode:
Part 2: Fill in if you come from abroad (international student) * Date when you arrived in UK: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 How many months will you stay in the UK? Have you lived or studied in the UK before? Yes    No Your UK address where registered with a GP: (only if you have previously registered with a GP) Town: Postcode: Name of Doctor or Surgery when at that address: Address of Doctor or Surgery: Postcode: If a previous resident in UK, date of leaving: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Supplementary Questions: Anybody in England can register with a GP practice and receive free medical care from that practice. However, if you are not 'ordinarily resident' in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside of the European Economic Area must also have the status of 'Indefinite leave to remain' in the UK. Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges. More information on ordinary residence, exemption and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment regardless of advance payment. The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purpose of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided. Please select one of the following options: More information... I understand that I may need to pay for NHS treatment outside of the GP practice I understand that I have a valid exemption for paying for NHS treatment outside of the GP Practice. I can provide documents to support this when requested This includes for example, an EHIC, or payment of the Immigratin Health Charge ("the Surcharge"), when accompanied by a valid visa. I do not know my chargeable status Complete the following section if you come from another EEA country: Do not complete this section if you have an EHIC issued by the UK. Do you have a non-UK EHIC or PRC? Yes   No Please enter details from your EHIC or PRC below: Country code: 3 Family Name: 4 Given names: 5 Date of Birth: (dd/mm/yyyy) 6 Personal Identification Number: 7 Identification Number of the Institution: 8 Identification number of the card: 9 Epiry Date: (dd/mm/yyyy) PRC validity period From: (dd/mm/yyyy) PRC validity period To: (dd/mm/yyyy) Tick here if you have an S1 (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... How will your EHIC/PRC/S1 date be used? By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purpose of cost recovery. Your clinical data will not be shared in the cost recovery process. Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.
* Email address:
* Confirm Email address:
* Signature:	Clear
Health Questionnaire
* Ethnic origin: Please select... British Irish Irish Traveller Traveller Gypsy/Romany Polish Any other White (please specify) White and Black Caribbean White and Black African White and Asian Any other Mixed (please specify) Indian Pakistani Bangladeshi Any other Asian (please specify) Caribbean African Somali Nigerian Any other Black (please specify) Chinese Filipino Any other ethnic group (please specify) Prefer not to say Other:     1st language: Need interpreter: Yes   No
SERIOUS ILLNESS, OPERATIONS OR DISABILITIES Please tell us if you have or have had any significant medical condition. For each item please tell us the year the event happened or when the problem started. (E.g. Mental Health Problems, Inflammatory Bowel Disease, Asthma, Diabetes, Arthritis, Epilepsy, Cancer, Transplant, Hearing or Sight Disabilities):
Please record any DISABILITIES here: (including any special communication needs)
Please list any DRUG ALLERGIES or ALLERGIC REACTIONS:
Please list any CURRENT MEDICATION, including inhalers. Please specify name, dose and freqency:
* Name: EMERGENCY CONTACT  * Phone no:   * Relationship:
* Height:  cm * Weight:  kg
Are you a CARER? Yes   No
* Do you SMOKE? Yes   No   Used to smoke
* Amount you used to smoke per day:     When did you stop?  * Amount you smoke per day:   Please select... Less than 1 per day 1 to 9 per day 10 to 19 per day 20 to 39 per day 40 or more per day   For help with stopping smoking, please visit www.smokefree.nhs.uk or text TXTHELP to 63818. * Tick here to confirm that you have read the information above:
EXERCISE - In an average week how often do you take exercise which leaves you mildly out of breath, and makes you perspire slightly? No regular exercise Less than 1 hour of physical exercise each week More than 1 hour but less than 3 hours of physical exercise each week More than 3 hours of physical exercise each week
How often do you have a drink that contains ALCOHOL? Never (0) Monthly or less (1) 2-4 times / month (2) 2-3 times / week (3) 4+ times / week (4) * How many alcohol units per week do you drink?     NHS Alcohol Unit Calculator
How many standard alcoholic drinks do you have on a typical day when you are drinking? 1-2 (0) 3-4 (1) 5-6 (2) 7-9 (3) 10+ (4)
How often do you have 6 or more standard drinks on one occasion? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
If your total alcohol score above is high it may indicate hazardous or harmful drinking. Please then complete the more detailed questions below (score in brackets):   How often during the last year have you found that you were not able to stop drinking once you had started? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)   How often during the last year have you failed to do what was normally expected from you because of your drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)   How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)   How often during the last year have you had a feeling of guilt or remorse after drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)   How often during the last year have you been unable to remember what happened the night before because you had been drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)   Have you or somebody else been injured as a result of your drinking? No (0) Yes, but not in the last year (2) Yes, in the last year (4)   Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? No (0) Yes, but not in the last year (2) Yes, in the last year (4)
Your alcohol score is: 0 0 – 7: Lower risk, 8 – 15: Increasing risk, 16 – 19: Higher risk, 20+: Possible dependence Further information can be found in the Alcohol section of our website.
Summary Care Records (SCR)
The NHS in England has introduced the National Summary Care Record. The record will contain information about your health. This will ensure those caring for you have enough information to treat you safely. Records are kept securely on computers separate from the medical record Saville Medical Group will keep for you. Records are created for you by default unless you choose to opt out. For more information about NHS sharing you can talk to the Patient Advice and Liaison Service (PALS) on 0800 0525 270 or visit www.nhscarerecords.nhs.uk You can choose not to have a Summary Care Record and you can change your mind at any time. If you do nothing we will assume that you are happy with these changes and create a Summary Care Record for you. I have read the information regarding SCR and wish to opt-OUT (not to have an SCR):
By completing this questionnaire you will automaticall be enrolled in Patient Access online, which will enable you to book appointments, order repeat prescriptions and view your medical records online. Please contact the practice 4 weeks from today to complete the registration process. If you do NOT want to be enrolled in Patient Access, please tick here:
Organ Donation If you are interested in becoming an organ donor, please click this link to go to the organ donor registration page.
Blood Donation 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.
IIf you are worried about this you can instead obtain a form from the medical practice that can be filled in and delivered by hand.
* = Compulsory.