Registration Form - GMS1w

Cofrestru gyda gwasanaethau meddyg teulu/Family doctor services registration

ANY SECTION UNFILLED WILL RESULT IN LATE REGISTRATION OR REGISTRATION MAY BE REJECTED. IF THEY ARE UNABLE TO FILL ONLINE FORM OR SUBMIT MANDATORY INFORMATION THEN THEY HAVE TO ATTEND THE SURGERY IN PERSON FOR REGISTRATION.

Last Updated: 14/11/2024

  • Patient's details

    Dyddiad geni/Date of Birth
    For example, 15 3 1984
    Rhyw/Gender

  • help us trace your previous medical records

    Helpwch ni i olrhain eich cofnodion meddygol blaenorol drwy ddarparu’r wybodaeth ganlynol 

  • Os ydych o dramor/If you are from abroad

    Os oeddech yn arfer byw yn y DU, dyddiad gadael/If previously resident in the UK, date of leaving (optional)
    For example, 15 3 1984
    Ydych chi erioed wedi cofrestru â Meddyg Teulu y GIG yn y DU?/Have you ever registered with a NHS GP in the UK? (optional)
    Y dyddiad y daethoch gyntaf i fyw yn y DU/Date you first came to live in UK (optional)
    For example, 15 3 1984

  • lluoedd arfog/HM armed forces?

    Ydych chi erioed wedi gwasanaethu fel aelod o luoedd arfog ei mawrhydi?/Have you ever served in HM Armed Forces? (optional)
    Dyddiad ymrestru/Enlistment date (optional)
    For example, 15 3 1984
    Dyddiad gadael/Discharge date (optional)
    For example, 15 3 1984

  • Os oes angen i’ch meddyg weinyddu meddyginiaeth a theclynnau meddygol* Nid oes awdurdod gan bob meddyg i weinyddu meddyginiaeth/If you need your doctor to dispense medicines and appliances*Not all doctors are authorised to dispense medicines

    Os oes angen i’ch meddyg weinyddu meddyginiaeth a theclynnau meddygol* Nid oes awdurdod gan bob meddyg i weinyddu meddyginiaeth/If you need your doctor to dispense medicines and appliances*Not all doctors are authorised to dispense medicines (optional)

  • Eithrio o Gofnod lechyd Unigol y GIG/NHS Individual Health Record Opt Out

    Rwy’n dymuno eithrio o’r Cofnod lechyd Unigol ac atal staff meddygol sy’n darparu gofal brys rhag gweld fy ngwybodaeth feddygol allweddol. Rwyf wedi derbyn digon o wybodaeth i wneud dewis gwybodus ac rwy’n cydnabod y gallai eithrio fel hyn amharu ar fy ngofal iechyd. Mae rhagor o wybodaeth ar gael yn www.wales.nhs.uk/cofnodiechydunigol neu drwy ffonio Galw lechyd Cymru ar 0845 46 47 (optional)
    I want to opt out of the Individual Health Record and prevent emergency care medical staff being able to access my key medical information. I have received enough information to make an informed decision and I acknowledge that opting out could be detrimental to my healthcare. Further information is available by visiting www.wales.nhs.uk/individualhealthrecord or by calling NHS Direct on 0845 46 47 (optional)

  • Cymraeg/Welsh?

    Ticiwch y blwch yma os hoffech chi dderbyn gohebiaeth oddi wrthym yn y Gymraeg/Please tick this box if you wish to receive correspondence from us in Welsh (optional)

  • Llofnod/Signature

    Dyddiad/Date
    For example, 15 3 1984

  • OFFICE USE

    I have accepted the patient for General Medical Services on behalf of Bishops Road Medical Centre (CF14 1LT) - W97028. 

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