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Smartcard Request Form
Please use this form if you do not have a NHS smartcard already issued in your name and are unable to get a sponsor to complete a request via Care Identity Service (CIS) portal.
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* Indicates required question
1. Full name (please give your GPHC registered name)
*
Your answer
2. Confirm that you live in Bolton
*
If you live in other areas of Greater Manchester please complete the form on the GM LPC website
https://psnc.org.uk/greater-manchester-lpc/resources/smartcard-access/
. If you live outside of Greater Manchester you will need to contact the local RA in the area that you live in. Details can be obtained here:
http://bitly.ws/6cXT
Yes
3. Home Postcode - to match documents on ID check appointment:
*
Your answer
4. Preferred contact telephone number
*
Your answer
5. Email address
*
Your answer
6. GPHC number
*
Your answer
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