You can register with the practice online:
If you are struggling to do the form online, please call into the surgery where the reception team will give you a paper copy of the form for you to fill out and return. Should you require assistance with this, one of the team will be happy to help. We are aware that our patients have differing accessibility requirements and we are dedicated to providing a high level of service to all of our community.
PLEASE try to fill out as much of the form as possible. If you leave out important pieces of information there may be a delay in your registration.
Please note as part of addressing health inequalities within different parts of our community, we ask some personal information regarding your protected characteristics to help us KNOW our patient population. All of these include the option for you to not give this information – so if you feel that this is something you’d prefer not to answer, we have included the option to select “prefer not to say”.
If you are taking regular medication, it may be a good idea to obtain a copy of your full prescription from your previous surgery before you register with the practice. This will mean we have proof of your medications while we are still waiting for your records from your previous surgery.
Click here for the Proxy Access information
Click here for the Named Accountable GP information
Please feel free to register any family members who are not already registered here. You can do this by filling out another registration form for each individual. We welcome families!
Click here for the form if you need to register as a temporary resident
Please click here to see our practice policy regarding controlled medications that are considered to be high risk.
PLEASE NOTE IF YOU TICK YES TO THE QUESTION IN THE FORM ABOUT CONTROLLED MEDICATION WE WILL NEED TO VERIFY THE DRUGS YOU ARE TAKING – please read the policy and ensure if marking YES, that you are currently prescribed one of the drugs from the list.
Alcohol - alcohol use can affect your health and can interfere with certain medications and treatments. Yours answers will remain confidential so please be honest.
Do you have, or have had any serious health problems (including operations/long term conditions)?
Have any of your immediate relatives (brothers/sisters/parents) had any of the following?
The doctor may discuss with you the possibility of transferring your care to a local hospital
If yes, please complete details below
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure
connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
New Islington Medical Practice
Ancoats Primary Care Centre, Old Mill Street, Manchester, M4 6EE.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.