New Asylum Seeker Registration

Patient’s Details

Title *
Please use this date format: DD/MM/YYYY
Sex *
Current hotel: *
Do you need an interpreter for appointments: *
Have you previously lived in another part of the UK? *

Appointment Details

Do you want a face-to-face new patient medical assessment with a GP? *

Tuberculosis

Do you currently have any of the following symptoms lasting for more than 3 – 4 weeks?
Tick all that apply
Have you had tuberculosis in the past? *

Current Medical Problems

Do you have any of the following symptoms?
Tick all that apply
Have you ever had any of the following?
Tick all that apply

Mental Health

Do you currently have any of the following symptoms?
Tick all that apply