Change of Personal Details

It is important that we have up to date contact details in case we need to contact you. Please let us know as soon as possible if you change your address, telephone number or name.

Before submitting this form please check to make sure your new address falls within our practice boundary. If not you will need to register with a new surgery.

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.

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Change of Address

  • Update Contact Details

    Do you consent to being reminded by text for appointments? (optional)
    This form collects your name, date of birth, email, and other personal information. This is to confirm you are registered with the practice, to allow the practice team to contact you and update your medical records held by the practice. Please read our privacy policy to discover how we protect and manage your submitted data.
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: 20 August 2024
Page created: 12 October 2026