Register as a temporary patient form Surname First name(s) Previous names (if applicable) Your date of birth Sex Male Female Telephone Email address NHS No. An NHS number is a 10-digit number, like 485 777 3456. If known, please enter your NHS number in the field below. You can find more information on the NHS website Your current home address Home address (permanent) Current GP practice name Current GP practice address Start date of temporary registration End date of temporary registration (if known) Reason for temporary registration I consent to the temporary registration and care provided by the GP practice Signature Write your full name Date of submitting the form