New student registration request

Please indicate you would like to register with the University of Salford Health Centre by completing the form below. A member of the Health Centre Team will be in touch within the next 5 days to complete the registration form.

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

Your confirmation *

I consent to the practice collecting and storing my data from this form.

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New student registration request

Privacy Policy

University of Salford Health Centre

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