Updating your contact details

If you change your name, home address, email address or phone number, please let us know by completing the form below.

Patients that move out of the local area can request to remain registered with the Practice

Patients that move out of the local area can request to remain registered with the Practice if their health care needs can be safely met and they are able to attend the Practice for appointments. Home visits are generally not available for out of area patients.

Which Tower site are you registered at?*
Title*
First name(s)*
Surname*
Date of birth*
DD slash MM slash YYYY
Date of change*
DD slash MM slash YYYY

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
Find your NHS Number
Sex*
- Male
- Female
- Not specified
Email*
Enter Email Confirm Email
Old address
Street Address Address Line 2 Town/City County Postcode
Old telephone number
New address
Street Address Address Line 2 City/Town County Postcode
I do not have a landline number
Please tick this if you do NOT have a landline and it will remove the box below asking for this number.
- I don't have a landline number
Landline number*
I do not have a mobile number
Please tick this if you do NOT have a mobile phone and it will remove the box below asking for this number.
- I don't have a mobile number
Mobile telephone number*
Having your mobile number allows us to send text reminders and invitations for appointments as well as important information relating to your health and care we provide at Tower Family Healthcare. We will never pass on your details to a third party.
Consent*
I agree to the privacy policy.
Please note that no medical information or questions will be responded to. The data you supply on this form will be stored on our website, which is hosted by a third party, until it has been processed by the practice. The data will be used lawfully, in accordance with the Data Protection Act 2018, which gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly. We will retain your information on this website for no longer than 7 days. The practice privacy policy can be viewed on this website.
Comments
This field is for validation purposes and should be left unchanged.

01204 885 106

01204 885 106

Patients that move out of the local area can request to remain registered with the Practice

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