Out of Area Registered Patients Application

If you are still living in Birmingham and would like to apply as an ‘Out-of-Area Registered Patient’, please complete this form. The Practice Partners will review your application and inform whether we can accept you as an out-of-area patient within 28 days.

Last Updated: 18/09/2024

Application Form

Name *

Date of birth *

Old address *

New address *

Patient Statement

I would like to register as an ‘Out-of-Area Registered Patient’ at Bournbrook Varsity Medical Centre. *

Agree

Disagree

I understand that Bournbrook Varsity Medical Centre will not provide home visits or other urgent care to me when outside the practice area. *

Agree

Disagree

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Out of Area Registered Patients Application

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