Change of Contact Details Form Name First Last Email Date of birth DD slash MM slash YYYY Please use format day/month/year e.g. 12/05/1979I wish to inform the practice of: Change of Name Change of Address Change of Phone Number Change of Email Address Privacy PolicyThis 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.Your consent I consent to the practice collecting and storing my data from this form.
