Laxey & Village Walk Health Centres at 1 The Village Walk, IM3 4EA & New Road, IM4 7BF

Register as a new patient

Use the form below to register

Register (GSM1)
Title:
Sex:
Address
Address
Postcode
City
Country

Please help us trace your previous medical records by providing the following information:

Your previous address
Your previous address
Postcode
City
Country
Address of previous doctor
Address of previous doctor
Postcode
City
Country

If you are from abroad:

Your first address where registered with a GP
Your first address where registered with a GP
Postcode
City
Country

If you are from the Armed Forces:

Address before enlisting
Address before enlisting
Postcode
City
Country

If registering a child under 5:

If you need your doctor to dispense medicines and appliances * :

* Not all doctors are authorised to dispense medicines.

NHS Organ Donor registration:

I would like to join the NHS Organ Donor Register as someone whose organs may be used for transplantation after my death.

Please tick as appropriate:
Or only my:

NHS Blood Donor registration

Emergency Contact

Address:
Address:
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