Student Patient Registration (page 1 of 2)

Please fill in your details and click Next when complete. * = compulsory

Please only complete this registration form once. If you have previously submitted this form
at any time please do not do so again unless advised by the Student Health Centre to do so.
Please do not use this form to update your address or other details.

Have you registered with Exeter Student Health before?   
9 number student ID
Department where you will study at university
Study course at university
Undergraduate or Postgraduate?    
 Year you start or started at Exeter
  Year due to finish at Exeter
   
* Title:
Your family surname as it appears on your passport As on your passport
Please enter all your first names in full, as they appear on your passport As on your passport
 
If you don't know your 10 digit NHS number it's very important that you fill in part 1 and 2 below
Gender:
lease give details:  
 Where were you born?
 
* Select your new Exeter address from the lists below
 if you are staying in university accommodation: Select your accommodation from this list. Disregard if you are in other accommodation
Halls:
Do not worry if you don't know your house/block/flat or room number- just fill in
the details you have been provided by the university - we can add the rest later.
House/Block/Flat:
Room no (if confirmed):
* or: Type in your Exeter address below if you are
not staying in university accommodation: Your address if you are not in university accommodation. NOT your old home address

Enter your own telephone number. Preferably your mobile number
University e-mail address. A confirmation will be sent to this address.
Your personal e-mail address.
Please help us trace your medical records by selecting if you are a UK or International
student (Part 1) and then filling in the next section (Part 2)
* Part 1. Select if you are from UK or abroad:
Part 2: Fill in if you come from the UK




Part 2: Fill in if you come from abroad (international student)
You can't register before you arrive in the UK
Have you lived or studied in the UK before?    
We find that SMS/text messaging and e-mail are often the most efficient methods of contacting patients about routine matters.
E.g. to remind you of an appointment or give you test results. Please note we will only use the secure
university email system to communicate with you for essential purposes concerning your health.
We will never use text or e-mail to send confidential medical information.
Tick this box if you don't want us to contact you by e-mail:
      Tick this box if you don't want us to contact you by SMS/text:
* Signature:
Please draw your unique signature in the box
By ticking this box I confirm that I have filled
in this form to the best of my knowledge
and signed it with my own unique mark.
Please note: The information you are submitting will be passed to the Student Health Service over the Internet which is not 100% secure. If you are worried about this you can instead obtain a GMS1 from the Health Centre which can be filled in and delivered by hand or post.
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