HOW DO I....?
...Change Of Patient Details?

Please ensure that we have a record of your correct address and contact telephone number(s) in order that we can amend our records. This will help avoid inconvenience to patients when we need to cancel appointments at short notice due to unforeseen circumstances. It will also allow us to notify the hospital of the correct patient details in the event of a referral being required, thus avoiding delays in appointments being notified. We will only contact patients on a mobile telephone number in an urgent/emergency situation. Therefore, it is important that patients provide a landline telephone number wherever possible. Patients can change their details via our website www.lyndhurstroadsurgery.co.uk. FAILURE TO PROVIDE US WITH YOUR CORRECT ADDRESS AND CONTACT DETAILS MAY JEOPARDISE YOUR REGISTRATION WITH THE PRACTICE.

You can now use the change of patient details form below to inform the surgery of any changes.

Change Of Patient Details

Title:

First Names:

Last Name:

Date of Birth
(dd/mm/yyyy):

Your Usual Doctor:

Email Address:

Change of Name

New Title:

New Surname :

New Forename :

Change of Address/Telephone Number

Old Address 1:

Old Address 2:

New Address 1:

New Address 2:

New Postcode:

New Home Phone No :

(Including STD code)

New Mobile Phone No :

New Work Phone No :

CONFIDENTIALITY - TERMS AND CONDITIONS:
The internet is not secure, and the transmission of data to request medication is entirely at the patient's own risk. The practice accepts no responsibility for breaches in confidentiality resulting from patients' transmissions.

I accept the terms and conditions above