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 this form into the surgery along with a copy of the appropriate document (requirement of Department of Health).

Alternatively, if you are changing the name of a patient who is under the age of 16, please complete this form.

Changing your address or telephone number

Please complete the online form below.

You may be eligible to register as an Out of Area Patient. Please contact the surgery for advice.

Please use this date format: DD/MM/YYYY.
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.
i.e. do you live more than one mile in a straight line from ANY pharmacy?