Bryngwyn Surgery

4-6 Bryngwyn Road, Newport, NP20 4JS

Telephone: 01633 263463

enquiries.w93046@wales.nhs.uk

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New Patients

New Patients

Patients wishing to register can complete this form. They will then receive contact from the practice to finalise registration.

You will need proof of address and photographic ID to be registered without visiting the surgery.

Alternatively you can download the GMS1-family-doctor-services-registration-form and New Health Questionnaire 2023 – Mandatory and return the to the surgery enquiries.w93046@wales.nhs.uk with a copy of your proof of address and photographic ID.

Family Doctor Service Registration

Patient details
Title*
Date of Birth*
DD slash MM slash YYYY
Gender*
NHS Number
First Names*
Birth Town*
Surname*
Birth Country*
Current Address and Postcode*
Telephone*
Mobile*
Email Address*
Please help us trace your previous medical records by providing the following information
Have you previously been registered with an NHS GP in UK?*
- Yes
- No
Name of Previous GP*
Address of Previous GP*
Your Previous Address
This is usually the address when you were last registered with a GP
Your first UK address*
Date you first came to UK
DD slash MM slash YYYY
Are you returning from the Armed Forces?*
- Yes
- No
Please indicate if you have ever served in the UK Armed Forces and/or been registered with a Ministry of Defence GP in the UK or overseas*
- Regular
- Reservist
- Family Member
Address and Postcode before enlisting*
Service or Personnel Number*
Enlistment date*
If you are registering a child under 5
Child Health Surveillance
- I wish the child above to be registered with the named doctor for Child Health Surveillance
If you need a doctor to dispense medicines and appliances
Nearest Chemist
- I live more than 1 mile in a straight line from the nearest chemist
Chemist Difficulty
- I would have serious difficulty in getting them from a chemist
Signatures
Signatures*
- Patient's signature
- Signature on behalf of patient
Consent
I agree for the Practice to contact me using the details provided above.
Electronic Signature (Type your full name here)*

By completing the section above, I hereby sign this form electronically
NHS Organ Donor Registration
Would you like to join the NHS Organ Donor Register?*
- Yes
- No
- Already on it
I want to register my details on the NHS Organ Donor Register as someone whose organs/tissue may be used for transplantation after my death.*
- Any of my organs and tissue
- Kidneys
- Heart
- Liver
- Corneas
- Lungs
- Pancreas
NHS Blood Donor Registration
Would you like to join the NHS Blood Donor Register?*
- Yes
- No
- Already on it
Tick here if you have given blood in the last 3 years
- I have given blood in the last 3 years
My preferred address for donation is:
Comments
This field is for validation purposes and should be left unchanged.

92224

GMS1-family-doctor-services-registration-form

Opening Times

Monday
08:00am to 06:30pm
Tuesday
08:00am to 06:30pm
Wednesday
08:00am to 06:30pm
Thursday
08:00am to 06:30pm
Friday
08:00am to 06:30pm
Saturday
CLOSED
Sunday
CLOSED

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Staff Login | Privacy Policy | Accessibility

Accessibility Tools

Update your details

Name*
First Last
Date of Birth*
Address*
Phone*
Email*
Smoking Status*
How many per day?*
Phone
This field is for validation purposes and should be left unchanged.

53458

Prescriptions

Name*
First Last
Date of Birth*
Telephone*

If there are any problems with issuing your prescription, we may call you to let you know.
Medications required*
Email Address*
Phone
This field is for validation purposes and should be left unchanged.

98203

Make an Enquiry

Name*
Date of Birth*
Telephone
Email*
Message*
Email
This field is for validation purposes and should be left unchanged.

21962

Submit your blood pressure readings

Name*
Date of Birth*
Telephone
Email*
Message*
Comments
This field is for validation purposes and should be left unchanged.

64868

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