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.

Changing your name

Please download, complete and bring your form into the surgery along with a copy of the appropriate document.  Patients aged 18 and over can change their name using any document showing they use the name in everyday life.

If you are changing the name of a patient who is under the age of 16, please complete the ‘under 16’ form.  Please note the special requirements to change the name of a child.  We need to ensure that everyone with parental responsibility has agreed to the change. You can do this by letting us have sight of the original enrolled deed poll – we cannot accept photocopies as we need to see the watermark and seal.   You can use an unenrolled deed poll if you can also provide proof that either there is no other person with parental responsibility or they have also agreed to the name change.  Deed polls obtained from online companies are unenrolled and need to be enrolled with the Royal Courts of Justice.

If a parent wants to change the name of a young person aged 16 or 17, rules apply per under 16’s.  If the young person wants to change their name, providing they have capacity to consent, rules apply per over 18’s.

See information on deed  polls on the official gov.uk website here

See gov.uk information on parental responsibility here

See the UK deed poll service website here

Link to downloadable documents

Changing your address or telephone number

Please complete the online form below.

Have you moved within our Practice area? *

Yes

No

Have you been accepted as an Out of Area patient? *

Yes

No

We are unable to change your address if not in our Practice Area. However, you may be eligible to register as an Out of Area Patient. Please complete the Out of Area Registration Form. Please note, you will not be registered until the process is complete and you receive confirmation.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Email Address: *

By giving us your email address on this online form, we assume consent to reply to this form via email when necessary. If you prefer not to receive email, please contact the surgery by telephone.

Do you have any communication/information needs relating to disability, impairment or sensory loss?

Yes

No

Please be specific:

Title

Dr

Mr

Mrs

Miss

Ms

Other

Please specify:

New address, including postcode:

Previous address, including postcode:

New Phone Number:

Named GP (if known):

Which pharmacy do you normally use?

Do you have home oxygen?

Yes

No

Please list all family members moving with you: