Update Your Contact 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. Failure to provide us with your correct address and contact details may jeopardise your registration with the practice.

In addition to our current formal practice area, the practice has an outer boundary area so that registered patients who move home between these areas can stay registered with the practice, if they wish, unless the practice believes it would not be in the patient’s interests to do so. Please refer to the Practice Area Map section for details of practice boundaries.

Previous Details

Full NameIncluding Title

Can you provide your Previous NHS or Patient Number?This will allow us to locate you quickly on our Patient Database.

NHS Number

Previous Address

Previous Postcode

Previous Contact Details

E-mail Address

Home Phone Number

Mobile Phone Number

New Details

Provide details where different to previous.

New Full Name, if changedIncluding Title

Date of BirthDD/MM/YYYY

Can you provide your New NHS or Patient Number?This will allow us to locate you quickly on our Patient Database.

NHS Number

New Address

New Postcode

New Contact Details

E-mail Address

Home Phone Number

Mobile Phone Number

Education

Are you a Student?

Additional Family Members

Name of additional family member 1

Date of Birth of family member 1

Name of additional family member 2

Date of Birth of family member 2

Name of additional family member 3

Date of Birth of family member 3

Name of additional family member 4

Date of Birth of family member 4

Name of additional family member 5

Date of Birth of family member 5

Add Family Member

Hospital Referrals

Have you been referred to a Hospital?

Privacy

I agree that the surgery may contact me by e-mail or telephone to discuss the information contained in this form.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to The Lyndhurst Medical Centre • 41 Lyndhurst Road, Barnehurst, DA7 6DL.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Local Services

Home
Care