Change your personal details Who are you completing this form for? Yourself Someone else For example, on behalf of a child or dependent What is your name? First Last What is your name? Optional DD slash MM slash YYYY What is your sex? Male Female Other As recorded on your medical record What is your postcode?The one used to register with your GP What is your phone number?What is your email address? Anyone else with access to your email account may see responses sent to youPlease select the information you are wanting to update? Name Optional Address Optional Contact Numbers Optional Change of NamePrevious Surname:If your name has changed due to Marriage or by Deed Poll, can you please provide us with a copy of the appropriate document (requirement of Department of Health).How do you wish to be known? Dr Mr Mrs Miss Ms Other Change of AddressNew address, including postcode: OptionalPrevious address: OptionalPlease list all family members moving with you: OptionalOnly if they are registered at this practice. Update Contact NumbersWould you have any objection to being reminded by text for appointments? Yes Optional No Optional New mobile number: OptionalNew home phone number: OptionalNew work phone number: Optional