Adult NHS Registration Form

Step 1 of 3
ie Mr, Mrs, Miss, Dr, Ms, Mx
Please provide us with your maiden name (if applicable)
We need this 10 digit number to register you as an NHS patient. You must be registered with a GP in Northern Ireland only.
Do you pay for your NHS Treatment?
Specify your Exemption Benefit below

NHS Dental Care is NOT universally free for all adults in Northern Ireland; it is only free for specific eligible groups, including children under 18, students under 19, pregnant women/new mothers, and those on specific low-income benefits.

Are you entitled to Claim? For further info, follow the guidance by clicking on the link below:

Help With Dental Costs

Are you claiming Universal Credit? For further info, follow the guidance by clicking on the link below:

NI Direct Help With Health Costs

Please specify which Benefit you receive
These are the only benefits that may cover your NHS Treatment. Please bring proof of your benefit to your appointment
Do you require a ground floor surgery?
Do you require an interpreter?
If yes, please state the desired nationality below