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The Docs NHS GP Surgery in Manchester

New baby registration

New Baby Registration

Baby’s Details

Title: *

Mr

Miss

Ms

Other

Please specify:

Surname: *

First Name: *

Gender: *

Male

Female

Date of Birth: *

Please use format DD/MM/YYYY

Town and Country of Birth:

Current Manchester address: *

Postcode:

Home Telephone Number:

NHS Number:

Ethnicity

Please select the one that best describes your baby:

White British

White Irish

Gypsy or Irish Traveller

White and Black Caribbean

White and Black African

White and Asian

Indian

Pakistani

Bangladeshi

Chinese

Black Caribbean

Black African

Somali

Arab

Other

Please specify:

Parent/Guardian Details

Parent/Guardian’s Full Name: *

Parent/Guardian’s Date of Birth: *

Please use date format DD/MM/YYYY.

Parent/Guardian’s Mobile Telephone:

Parent/Guardian’s Work Telephone:

Email Address: *

Signed: *

Please put the name of parent/guardian.

Date:

If you are human, leave this field blank.

55-59 Bloom Street
Manchester
M1 3LY

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0161 237 9490

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