Copy of - Application to Register with a General Medical Practitioner - GPR (Scotland)

Fields marked REQUIRED are compulsory. You should only send this form if you are sure that you are eligible to join this practice. Sending this form will NOT automatically register you with the surgery. Sending this form does NOT guarantee or even imply that you will be accepted onto the practice register By sending in this form you are agreeing to receive email and/or sms communications from us. We will only use this information to communicate with you about Penicuik Medical Practice and the service we provide.

Last Updated: 18/05/2022

Personal Details




















Please help us to trace your medical records by providing the following information:





If you are from abroad




If you have served in the British Armed Forces








Allergies and medication



Patient Declaration

I declare that the information I have given on this form is correct and complete. I understand that, if it is not, appropriate action may be taken. To enable NHS National Services Scotland to confirm my eligibility to lawfully register with a GP and for the purposes of prevention, detection, and investigation of crime, relevant information from this form will be disclosed to the NHS Business Services Authority, NHS National Services Scotland, the Home Office, Identity and Passport Service, HM Revenue and Customs, the General Register Office and Local Authorities.