Registration form

Thank you for your interest in registering with the James Wigg Practice.  We now work in partnership with the newly rebuilt Queens Crescent Practice located nearby.

The boundary for registering with the James Wigg Practice is defined by the streets inside the following roads: Bartholomew Road, Kentish Town Road and Leighton Road, Prince Of Wales Road, Havistock Hill and Mansfield Road.

The Queens Crescent Practice enjoys the larger area previously offered by the James Wigg Practice as identified on the map under the contact section of the website. 

The Queens Crescent Practice gives you the best of both worlds - a homely, friendly and intimate setting in high quality premises; while also giving you access to the great range of services and facilities of the Kentish Town Health Centre.  Many of the clinical and administrative staff work across both sites to provide an excellent standard of care.

New patients can register with either practice online by completing the  form further down this page. It would help us if you fill in as much information as you have available, but items marked with * must be completed.
Please submit a separate form for each family member.

Please check that you live within one of the practice catchment areas by referring to the map of the practice boundary in the information section.

On completion of the registration form we would draw your attention to the information concerning the NHS Summary Care Record. Details available at this link.  There is also an option to opt out of the Summary Care Record.

Summary Care Record Leaflet Summary Care Record Opt Out Form

NHS Family doctor services registration

Patient's details

* Surname
* First Names
Previous surname
* Gender
* Date of birth
* Town & country of birth
* Current home address
* Postcode
Telephone number
NHS Number

Medical records

Please help us trace your previous medical records by providing the following information

* Your previous address in UK
* Name of previous doctor while at that address
* Address of previous doctor

If you are from abroad

Your first UK address where registered with a GP
If previously resident in UK,
date of leaving
Date you first came to live in UK

If you are registering a child under 5

I wish the child above to be registered with a Doctor from the James Wigg Practice for Child Health Surveillance.