Temporary New Patient Registration

If you would like to register with the practice as a temporary patient, please use this form.

Temporary New Patient Registration

Patient's Details

Anyone over 16 years of age will need to email photographic ID to kingslangleysurgery@nhs.net to complete their registration.

Title *
Please use this date format: DD/MM/YYYY.
Gender *
Any responses we send will go to this email address.
Can we contact you by text?
Can we contact you by email?


Please specify the ethnic group you consider you belong to:
Do you speak English?
Do you read English?

Temporary Address (If Applicable)

Please include postcode.

Length of Stay

Please select how long your stay will be: *

Details of Treatment should be sent to:

Details of Treatment should be sent to the below details.