Change of Personal Details LS

Before submitting this form please check to make sure your new address falls 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).

Last Updated: 02/03/2021

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Change of Name

    How do you wish to be known? (optional)

  • Change of Address

    Please check your new postcode on the boundary map on our website before submitting your change request. If your new address falls outside our boundary you will need to register with another, more local practice.

  • Update Contact Numbers

    Do you consent to being reminded by text for appointments? (optional)

  • Update Email Address

    Please confirm consent to contact you by email? (optional)
    Please confirm that you have checked your new postcode on our boundary map if changing your address and will forward any necessary documentation to: medical.reports@nhs.net if changing your name.
    This form collects your name, date of birth, email and other personal information. 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.
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