Report a problem on the registration form
This is a form to tell us about problems or suggestions for this online registration form, so that we can improve it. The data from this form is stored in the EU and is only used to improve our products.

We are unable to assist with issues relating to your patient registration, such as if you have a query relating to your registration or the status of your registration. In this situation, please contact the GP surgery directly. 

You must not use this form to report medical issues. Remember, if there is a medical emergency, call 999 and if it's less urgent but still important, go to NHS 111 online, or call 111. If you have any other medical needs please contact the GP surgery directly. 

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✍️ What's your name?
💊 What problem with the form are you experiencing?
Please give us very specific details, the more detail the better. This is so we know where to look and we can fix things quickly for you!

An example answer: "I'm trying to put in a mobile number into next of kin and it is not recognising it". 
✨ What do you expect to happen?
⛔️ [SKIP AND IGNORE] ⛔️ 
This question is automatically filled out - you don't need to fill this question in! This is to help us locate the issue. 
⛔️ [SKIP AND IGNORE] ⛔️ 
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⛔️ [SKIP AND IGNORE] ⛔️ 
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