Patient Registration
Complete your Health Private registration form securely online.
Please complete the registration form below if you have been asked to register with Health Private or if you are preparing for an assessment, consultation or referral.
Before you begin
Please complete the form carefully.
The registration form helps Health Private collect the information needed before an appointment, assessment, consultation or professional referral can be considered.
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Use accurate contact details so Health Private can respond to your registration.
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Include relevant health, referral or appointment information where requested.
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Please do not use this form for emergency or crisis situations.
Registration Form
Health Private registration form.
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Secure online registration
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Emergency notice:
Health Private is not an emergency or crisis service. If you or someone else is in immediate danger,
call 999 or go to your nearest A&E. For urgent mental health support in the UK, contact NHS 111
or your local crisis team.