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Thank you for choosing to register with Fireclay Health.  You have two options:

  • simply click on both links below to complete both forms, clicking the 'send' button each time to send the form to us.  On receipt the Admin team will process the form and you will be able to make an appointment in two working days.

We require both a Pre-Registration form and a Medical Questionnaire to be completed for registration purposes. 

Note that by sending forms you will be transmitting information about yourself across the Internet - although every effort is made to keep this information secure, no guarantee of confidentiality can be offered.

a) Pre-registration Form (GMS1 form)

b) New Patient Medical Questionnaire

Please note: Although the GMS1 form includes options to register to be an organ and/or blood donor, this can no longer be acted on locally.  We ask that you register yourself if interested, with NHS Blood and Transplant - telephone 0300 123 23 23 or register online:

www.organdonation.nhs.uk  To register for organ donation, amend registration, refuse to donate or withdraw consent

www.blood.co.uk  New blood donors must be aged between 17-65. Registering online also gives you the ability to book and cancel appointments online, and view your recent donation history.


Alternatively you may print off both registration forms via the links below, to complete and bring with you on your first visit to the practice.

Registration Form   pdf

either ADULT (16+) Medical Questionnaire  pdf

or CHILD (0-15) Medical Questionnaire  pdf

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