Before handing in your of identity”, form and this “Proof “GMS1” “Additional Information” form, please read the following: I understand that it takes around 24 hours for my details to be registered with the practice I understand I need to see a GP before I can be issued with any repeat medication* * In an emergency, if you run out of medication before you are registered with us, you can speak to a pharmacist about getting an emergency supply. ETHNICITY White White White & Black – – – British Cornish Other Caribbean White & White & Asian Asian - – Black Asian Indian Pakistani African Asian - Black - – Black Other – Bangladeshi Caribbean African Other Country Chinese (please state Country): Next of Kin For emergencies – Optional information details only if you want to! – Name Address Contact Relationship Number
Before handing in your “Proof of identity”, “GMS1” form and this “Additional Information” form, please read the following: I understand that it takes around 24 hours for my details to be registered with the practice I understand I need to see a GP before I can be issued with any repeat medication* * In an emergency, if you run out of medication before you are registered with us, you can speak to a pharmacist about getting an emergency supply. White – British – Cornish White – Other White & Black Caribbean White & Black African White & Asian Asian – Indian Asian - Pakistani Asian - Bangladeshi Black – Caribbean - African Black – Other Chinese Other Country (please state Country): ETHNICITY Next of Kin – For emergencies Optional information – details only if you want to! Name Address Contact Number Relationship
Registration%20-%20Additional%20Information%20(A5).docx