Llantwit Major & Coastal Vale Medical Practice

Become a Permanent Patient

During Coronavirus (COVID-19) Period

We welcome new patients. Please check the Practice Boundary page to ensure that you reside within our catchment area.

We require all new patients to complete a registration form (GMS1W) and a health questionnaire which will provide useful information whilst we wait for your medical records to arrive from your previous doctor. Both forms can be found below.  We will accept two forms of identification that prove you live within the area, photo and one with proof of address. Your NHS number is also required to register, this can be obtained from your previous surgery.

If you are registering a newborn baby please only fill out the GMS1W Registration Form. 

For children under the age of 6 years old, please fill out the GMS1W Registration Form and the Child’s Health Questionnaire. Please see the following links for printable versions or alternatively scroll to the end of this form for an online submission.

GMS1W Registration Form

New Patient Registration Questionnaire for 6 Years+

GMS1W Registration in Word Format

Child’s Health Questionnaire

Please return forms via email. We also need to see proof of address within our area. Please take a photograph a form of identification or a document that provides us with your name and address.  Email: admin.w97045@wales.nhs.uk

We will accept a photograph of the completed form or alternatively all information required can be typed in an email; if you can not access a printer/adobe programs. Please note if you do not complete all information required or attach proof of address this will delay your registration.

For patient safety and confidentiality; please note by returning a completed form you are signifying you are who you say you are and all information is correct to the best of your knowledge. This will mean you also give permission for us to set you up as a New Permanent Patient at our Practice. 

New patient registration questionnaire (for 6years +)

Please complete all fields. We also require completion of the GMS1W form and proof of address within our catchment area. All the information you provide is strictly confidential

Your Lifestyle

1 unit = half a pint of beer or one glass of wine or a single spirit

Your Diet

Women only

Upload information

It is important you complete and upload the GMS1W form and proof of address or we cannot complete this registration.

Your Health

including any bought from the pharmacy
Before their 60th Birthday
If not applicable please write NA here

Other information

Please ensure the contact details you have provided are correct

Thank you for taking the time to complete this form. Please ensure you 'Send Message' below.

All fields marked (*) on this form are mandatory, please complete to the best of your knowledge. By using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your details.

Please ensure the contact details and information you have provided are correct. By submitting this form you understand and accept these conditions.

Further Information

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