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).

Please fill in the form below

    Step 1

    Present Name


    Date of Birth

    Email Address

    Step 2

    Previous Surname

    How do you wish to be known?

    Step 3

    New Address, Including Postcode

    Previous Address, Including Postcode

    Please list all family members moving with you

    Step 4

    Do you consent to being reminded by text for appointments?

    Number Type

    New Number (we will use this to contact you about your change of details)

    Are you happy for this phone number to be used for the purposes of contacting you about your change of details?

    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.