Change of Personal Details - Wansford Surgery & Kings Cliffe Practice

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 Name

Present Surname

Date of Birth

Please tell us what you would like to change

Name

Address

Contact Numbers

Email Address

Change of Name

If 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 Name

Previous Last Name

How do you wish to be known?

Upload Change of Name Proof Optional

Max. file size: 50 MB.

Change of Address

New address, including postcode

Previous Address Optional

Other members of your family requiring a change of address (if registered here)

Name

Date of Birth

Contact Numbers

Home Phone Number Optional

Mobile Number Optional

Can we send you appointment reminders by text message?

Yes

Update Email Address

New Email Address

Old Email Address Optional

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.

Email Optional

This field is for validation purposes and should be left unchanged.