Out of Area Request Form




Please complete our online form

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Information for consideration prior to out of area registration.

  • You have requested to register with our Practice as an ‘Out of Area’ patient.
  • You live outside the practice boundary and we want to make you aware of what this means for you under this type of registration. 

We may decide that it is not in your best interests or practical for you to be registered with us.

The practice is not required to provide you with a home visit

(this includes both doctors and any allied health professionals that are attached to the surgery, e.g. district nurses, community physiotherapists)

If you do require a home visit then you will have to contact the 111 service. They will direct you to the local service that has been established by NHS England for patients who need a home visit. This local service may be a GP practice near to where you live, the local walk-in or urgent care centre, A&E or minor injuries unit.

It is at the discretion of the Practice

As outlined in the service specification contract, that we can remove you from our list if we feel that your home address is affecting our ability to deliver care. The following are examples of this- 

  • If you make inappropriate use of the out of hours services (on weekends and weekday evenings), or attend casualty inappropriately.
  • if you fail to attend routine appointments at the surgery
  • if you develop a medical condition which makes you likely to become housebound in the future, or need regular medication (necessitating frequent appointments at the surgery)
Personal Details
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Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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