Change of contact details/name - The Springs Medical Partnership

Change of Personal Details

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).

Your Details

Present Name *

Forename *

Date of Birth *

Email Address *

Change of Name

Previous Surname

How do you wish to be known?

Mrs

Miss

Other

Update Contact Numbers

Do you consent to being reminded by text for appointments?

Yes No

Number Type

New Number

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. *

I consent to the practice collecting and storing my data from this form.

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Page last reviewed: 18 June 2024
Page created: 01 August 2024

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Change of Personal Details

Change of Personal Details

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