Updating your details – Eastgate Surgery

If you change name, address or telephone number, please let our receptionists know by calling or writing to us. Alternatively you can complete the online form. If you move outside the practice area you may need to find a doctor in your new area. There are instructions on what to do when you move to a new area on the back of your NHS medical card.

This form allows you to update your contact details and those of your household.

Title(Required)

First name(s)(Required)

Surname(Required)

Email(Required)

Enter Email Confirm Email

Date of birth(Required)

Date of change(Required)

When would you like us to update our records?

NHS Number

NHS number should be in the form nnn-nnn-nnnn for example: 123-456-7890

Sex(Required)

Male

Female

Old address

Street Address Address Line 2 City/Town County Postcode

Old telephone number

New address

Street Address Address Line 2 City/Town County Postcode

New telephone number

Other members of the family

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

Name 1

First Last

Date of birth 1

Name 2

First Last

Date of birth 2

Name 3

First Last

Date of birth 3

Name 4

First Last

Date of birth 4

Phone

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