Register for One Medicare @ Hilton Road

If you are a Leeds resident you can register as a patient of One Medicare @ Hilton Road.

To register for our surgery on Hilton Road, simply fill out the following form. Your enquiry will be sent to one of our members of staff, who will respond as soon as possible.

Make sure you complete all of the fields marked with an asterisk (*) and provide as much detail as you can so we can get back to you with all the information you need.

Your personal information will be treated in the strictest confidence and will not be made available to any third parties. Your details will be returned to you for checking and signing and you will be required to return the completed paperwork IN PERSON to the surgery along with a urine sample.

Please note to register as a patient at One Medicare @ Hilton Road you must live within the area of Leeds marked on the attached map: practice boundary postcodes. If you have any queries in the meantime please do not hesitate to contact us.

NEW! We are accepting applications for the NHS Online Prescription Ordering website. To use this service, simply fill in your details below and check the box confirming that you would like to be registered for NHS Online Prescription Ordering service. Your unique login details will then be forwarded to you via email.

Patient's Details

Title *

If 'Other' please enter *

Surname *

First Name(s) *

Previous Surname (if any)

Date of Birth *

NHS Number

Gender *

Town/City of Birth *

Country of Birth *

Current Contact Information

Current Address *

Town/City *

Postcode/Zip Code *

County/State *

Country *

Telephone Number *

Mobile Number

Email Address *

If you are registering a child under 5

I wish the child above to be registered with the doctor at One Medicare @ The Light for Child Health Surveillance

Records Tracing

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

Previous UK Address

Town/City

Postcode/Zip Code

Name of Previous Doctor

Doctor's Address

Town/City

Postcode/Zip Code

If you need your doctor to dispense medicines

Note: not all doctors are authorised to dispense medicines

I live more than 1 mile in a straight line from the nearest chemist

I would have serious difficulty in getting them from a chemist

Neither of the above applies

Return to Our Surgeries.

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