University Student Registration Form

University Student Form

It takes up to 10 working days to process your registration. To avoid delays, please provide all the information requested – otherwise our admin team will have to contact you for queries or missing information – together with all up-to-date contact details. Once your registration is complete, you will become a registered patient at Amwell Group Practice and will be able to access our full range of services that include completing a website eConsult for the doctor, booking an appointment with a member of our team and requesting your repeat medication. Please note: should you have an urgent health issue that really cannot wait and you believe needs to be dealt with urgently, please contact a member of our admin team who will be able to help if your registration is still being processed.

Personal Information

DD slash MM slash YYYY
Home Address
DD slash MM slash YYYY
DD slash MM slash YYYY

Organ & Blood Donation

Non-UK European Health Insurance Card (EHIC), Provisional Replacement Certificate (PRC) Details:

S1 form

The S1 form is a certificate of entitlement for state healthcare paid for by the UK government.
Max. file size: 50 MB.


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