New Patients

Thank you for considering registering with Chiswick Family Practice – Dr Bhatt and Dr Szyszko.

PLEASE COMPLETE ALL STEPS BELOW (1, 2, 3, 4 AND 5). PLEASE DO NOT OMIT ANY OF THE STEPS BELOW OTHERWISE WE WILL NOT BE ABLE TO FINISH YOUR REGISTRATION.

IMPORTANT: Failure to provide any of the supporting documents within 4 weeks of submitting the GMS1 – New Patient Registration form will result in the secure disposal of your application.

STEP 1:  Check if you live in our catchment area to avoid disappointment

We can only register patients who currently live within the Borough of Ealing (postcode W3/W4/W5).

Check now if your postcode is within our catchment area or find our operating area as shown on the map below.

Once confirmed that you live within our catchment area, please provide all the required information as listed below (STEPS 3, 4 AND 5), to ensure efficient completion of your registration as our new patient.

STEP 2: All forms (STEPS 3 AND 4) and documents (STEP 5) must be sent to the Admin Team at:

ADMIN.CHISWICKFAMILYPRACTICE@NHS.NET

STEP 3:  Complete and submit GMS1 – New Patient Registration form

To register with our practice please follow the link above (green button) to complete the online GMS1 – New Patient Registration form and provide patient information/details.

Please fill in ALL the below information in your form.

• Title
• Surname(s)
• First name(s)
• Date of birth
• NHS No.*
• Town and country of birth
• Gender
• Home address
• Postcode
• Telephone number

Additionally, please complete the section: “Please help us trace your previous medical records by providing the following information”.

If you submit the form for yourself (over 16 years old), please sign the document in ‘Signature of Patient’ section and clearly state the date of the signature.
However, if you submit the form on behalf of your child (under 16 years old), please sign the document in ‘Signature on behalf of patient’ section and clearly state the date of the signature.

* IMPORTANT: To find your NHS number, visit the following link: Find your NHS number.

* If you have never registered at GP Practice in England before and do not have an NHS number, please clearly state the date of entry to UK in the section “Date you first came to live in UK”. After completion of the registration, you will be assigned a new NHS number.

STEP 4:  Download, complete and email the relevant New Patient Questionnaire form

• Health Questionnaire – ADULTS (over 16 years old)

• Health Questionnaire – CHILDREN (under 16 years old)

STEP 5:  Email us a copy of your documents:

ADULTS (over 16 years old)

• 1 Form of Acceptable photo ID – Acceptable Identification: Photo Driving Licence, Passport – if not possible, please let us know
• 1 Form of Proof of Address – Tenancy agreement, Mortgage statement, Bank statement, Utility bill (date within the past 3 months) etc.
• IMPORTANT: Driving licence is an acceptable proof of ID but not an acceptable proof of address.
• IMPORTANT: BRP is not an acceptable proof of ID.

CHILDREN (under 16 years old)

• A copy of Birth certificate (in English) – to properly document the parents/guardians of the child who will assume the parental responsibility for the child.
• Immunisation record (in English) – it is necessary for successful completion of the registration of a child.

Please ensure that the documents supporting your registration application are provided in one of the following formats:
Documents: .JPEG; .PNG; .WORD; .WORDX; .PDF
Forms: .WORD; .WORDX; .PDF
Pictures: .JPEG ; .PNG; .PDF
Scans: .JPEG ; .PNG; .PDF

IMPORTANT: We aim to register you as quickly as possible, typically within 10 working days from the day we receive all required documents. We will send you an email confirming you have been registered.

IMPORTANT: Failure to provide any of the supporting documents within 4 weeks of submitting the GMS1 – New Patient Registration form will result in the secure disposal of your application.

Once registered, you can seek help/advice using our practice website e-consult option or by following the link: https://www.cfpdrsbhattandszyszko.nhs.uk/appointments/.

Disabled Patients:  Once registered, you will be able to telephone the practice from outside on arrival if you require any assistance in accessing the building or its services.