Update your Details Change Your Contact Details Tell us 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. Present First NamePresent SurnameDate of Birth DD slash MM slash YYYY Please tell us what you would like to change Name Address Contact Numbers Email Address Change of NameIf your name has changed due to Marriage or by Deed Poll, please provide us with a copy of the appropriate document (requirement of Department of Health)Previous First NamePrevious Last NameHow do you wish to be known?Please SelectMrMrsMissMsDrOtherUpload Change of Name Proof OptionalMax. file size: 50 MB.Change of AddressNew address, including postcodePrevious Address OptionalOther members of your family requiring a change of address (if registered here)NameDate of Birth Add RemoveContact NumbersHome Phone Number OptionalMobile Number OptionalCan we send you appointment reminders by text message? Yes No Update Email AddressNew Email Address Old Email Address Optional Next of KinFull NameRelationship to youContact NumberDo you give us permission to discuss your medical records with them? Yes No Privacy Policy I consent to the practice collecting and storing my data from this form. 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. The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.Comments OptionalThis field is for validation purposes and should be left unchanged.