Change of Personal Details

Before submitting this form please check to make sure your new address fall within our practice boundary. If not you will need to register with a new surgery. Please let us know as soon as possible if you change your address, telephone number or name. It is important that we have up to date contact details in case we need to contact you. Please note: If your name has changed due to Marriage or by Deed Poll, can you please provide us with a copy of the appropriate document (requirement of Department of Health).

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Change of Name

    Do you need to advise us of a change of name? If no, please move onto the next section
    Title (optional)

  • Change of Address

    Do you need to update your address? If no, please move onto the next section (optional)

  • Update Contact Numbers

    Do you need to update your contact numbers?
    Do you consent to being contacted by text messaging?
    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.

  • PLEASE PROVIDE YOUR EMAIL ADDRESS

The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.
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Page last reviewed: 22 November 2024
Page created: 08 October 2026