University of Southampton
GP Online Registration

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 Health Service to do so.
If you are unsure of your registration status, you can contact the practice who will be able to confirm this for you.  

Current patients: DO NOT use this form to update your address or other details.

Have you ever registered
with this practice before?
* Title:
Please enter your surname or family name
Please enter your first name
 If you don't know your NHS number it's very important that you fill in part 1 and 2 below
* Gender:  
Please enter your new ADDRESS in Southampton
 or select your accommodation from the list, if you live in halls
Select your university accommodation from this list. Disregard if you are in other accommodations.
Enter your own telephone number. Preferably your mobile number
Please help us trace your medical records by selecting if you are from the UK or International
(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
(i.e. the address your current GP will have for you)

* Are you currently in the UK?   

You cannot register with us until you are in the UK

Part 2: Fill in if you come from abroad (international student)
You can't register before you arrive in the UK
Have you lived or studied in the UK before?    
Supplementary Questions:
Please select one of the following options: More information...
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?   

(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
Health Questionnaire
* Ethnic origin:
Need interpreter:   
You are strongly advised to ensure you are fully immunised to UK Department of Health standards.
Please note: We provide ALL NHS immunisations for FREE.

Have You been vaccinated against Covid19?  

There is an increased risk of Meningitis, Measles, Mumps and Rubella due to the large numbers of students in the close
confines of a university campus, therefore it is important that you are vaccinated to protect both yourself and others
Have you ever had the following vaccinations?

Meningitis ACWY vaccine:
  Would you like to have
this immunisation?
1st MMR (measles, mumps, rubella) vaccine:    
2nd MMR (measles, mumps, rubella) vaccine:    
Tetanus vaccine:    

* Have you been diagnosed with any of the following CONDITIONS?
* Have you had/do you suffer from any other serious ILLNESS?    
* Have you had any significant INJURIES or OPERATIONS?    
* Do you have any DISABILITY/COMMUNICATION needs?    
* Do you suffer from any ALLERGIES?    
* Do you take any prescribed MEDICATION at present?    
(including the pill and depo-injections)
Patients are required to see a doctor for the first time a prescription for long-term medication is requested from us.
Make an appointment BEFORE your next repeat prescription is due. Thereafter, if it is
appropriate for you to receive repeat prescriptions the following points should be noted;
1. Request your repeat medication at least 1-2 weeks before you run out (in case an appointment is required)
2. It takes a maximum of 2 working days for repeat prescriptions to be processed
3. You will be required to see a doctor from time to time to review your condition and medication
* Do you SMOKE?     
* Amount you smoke per day:  
For help with stopping smoking, please visit or call 0845 602 4663.
Alternatively, most pharmacies run smoking cessation clinics.
How often do you have a drink that contains ALCOHOL?
NHS Alcohol Unit Calculator
How many standard alcoholic drinks do you have on a typical day when you are drinking?
How often do you have 6 or more standard drinks on one occasion?
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?
How often during the last year have you failed to do what was normally expected from you because of your drinking?
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
How often during the last year have you had a feeling of guilt or remorse after drinking?
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Have you or somebody else been injured as a result of your drinking?
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
Your total alcohol score is: 0
0 – 7: Lower risk, 8 – 15: Increasing risk, 16 – 19: Higher risk, 20+: Possible dependence
Questions for Anxiety
Over the last 2 weeks, how often have you been bothered by any of the following problems?
  Not at all Several
than half
the days
Feeling nervous, anxious or on edge:
Not being able to stop or control worrying:
Worrying too much about different things:
Trouble relaxing:
Being so restless that it is hard to sit still:
Becoming easily annoyed or  irritable:
Feeling afraid as if something awful might happen:
Your total Anxiety (GAD-7) score is: 0
 Questions for Depression
Over the last 2 weeks, how often have you been bothered by any of the following problems?
  Not at all Several
than half
the days
Little interest or pleasure in doing things:
Feeling down, depressed or hopeless:
Trouble falling or staying asleep, or sleeping too much:
Feeling tired or having little energy:
Poor appetite or overeating:
Feeling bad about yourself – or that you are a
failure or have let yourself or your family down:
Trouble concentrating on things, such as reading
the newspaper or watching television:
Moving or speaking so slowly that other people could have
noticed? Or the opposite – being so fidgety or restless
that you have been moving around a lot more than usual:
Thoughts that you would be better off dead
or of hurting yourself in some way:
Your total Depression (PHQ-9) score is: 0
Females only
Have you ever had a cervical smear/PAP test?  

Next of Kin
Who you would like us to contact in the event of an emergency

May we use email to contact you in future?   
May we use a text service to contact you in future?   
If considered necessary by a healthcare
pprofessional, may we contact your next of kin?
To maintain continuity of clinical care, we upload certain medical information so that it is
available to other healthcare organisations (e.g.  Emergency Departments).
Do you give your permission for us to upload data to
Hampshire Health Record?   
Summary Care Record (SCR):
Medications, allergies & adverse reactions?   
Medications, allergies & adverse reactions
& additional information?

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 website.
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.
* = Compulsory.
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