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John Street Surgery > Forms > Keep us up to Date > Change of Contact Details Form

Change of Contact Details Form

Change of Personal Details
Enter Email
Please use format day/month/year e.g. 12/05/1979

Change of Name

If your name changed due to Marriage or by Deed Poll please provide the practice with a copy of the appropriate documentation

Change of Address

New Phone Number

Privacy Policy

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.

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