You have 30 minutes to complete this form before data will be cleared from it. If you don't have your medical history information to hand please find this then refresh this form before starting.

Step 1 of 3

Our registration forms are secure, online and confidential and all information is held on NHS servers.

Applications typically take three working days to process. If you have a more immediate enquiry and are not yet registered please contact us by phone on 02380 449913.

Personal details

Please carefully fill out your personal details.

Have you been registered with Living Well Partnership or any of our surgeries before?
Do you have a religious affiliation?
Do you need a translator?