Change of Personal Details

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

Present Name *

Forename *

Date of Birth (DD/MM/YYYY) *

An Email Address on which we may contact you *

Change of Name

Change of Address

New Address, Including Postcode

Previous Address, Including Postcode

Please list all family members moving with you

Update Contact Numbers

Number Type (if more than one number is changing, please use the comments box below to provide information).

New Number

Comments

Do you consent to being reminded by text for appointments?

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. *

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

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.

I confirm the information I’ve given is correct and I understand how it will be used

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Page last reviewed: 29 January 2023
Page created: 13 October 2026

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Change of Personal Details

Further Information