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BBC Health News

Prostate cancer: New urine test hope26 Jun 2019 03:32The test sorts early cancers according to risk, so many men might be spared over-treatment, researchers say.
Child obesity drive 'stalled by Brexit'25 Jun 2019 02:10Slow progress is being made on junk food advertising restrictions and calories labelling, it is claimed.
Do you know the hygiene hot spots in your home?25 Jun 2019 02:14Where and when you should be cleaning to avoid infections and illness in your family, according to experts.
MMR vaccination rates in slight fall among children in Scotland25 Jun 2019 14:27Uptake rates from children receiving the vaccine by five years of age have dropped slightly but remains high at 96.6%
Pret allergy death: Parents 'delighted' by 'Natasha's law' plan25 Jun 2019 11:20The new rules follow the death of teenager Natasha Ednan-Laperouse who had a fatal allergic reaction.
Essex Strep A outbreak: Twelve people dead25 Jun 2019 16:06A total of 32 people were infected with the invasive Group A streptococcal infection, a report says.

Change of Contact Details

It is very important that you inform us of any changes. If you change your name we will require proof of this. We also require you to let us know as soon as possible any change of address and any new telephone numbers.

We do need to know how to contact you. Our records clerk may remove you from the list if we do not have your correct address, etc.

Documentary Proof

We will require proof of name or address changes so please bring this with you on your next visit to the practice.

1 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

2 Previous Address

Previous Address

Previous Postcode

3 Previous Contact Details

E-mail Address

Home Phone Number

Mobile Phone Number

4 New Details

Provide details where different to previous.

Full NameIncluding Title

Date of BirthPlease provide in the format dd/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

5 New Address

New Address

New Postcode

6 New Contact Details

E-mail Address

Home Phone Number

Mobile Phone Number

7 Education

Are you a Student?

8Additional Family Members

Family Member 1

Name

Date of BirthPlease provide in the format dd/mm/yyyy

Family Member 2

Name

Date of BirthPlease provide in the format dd/mm/yyyy

Family Member 3

Name

Date of BirthPlease provide in the format dd/mm/yyyy

Family Member 4

Name

Date of BirthPlease provide in the format dd/mm/yyyy

Family Member 5

Name

Date of BirthPlease provide in the format dd/mm/yyyy

9 Hospital Referrals

Have you been referred to a Hospital?

10 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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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
St Albans Medical Centre • 212 Richmond Road , Kingston upon Thames , Surrey , KT2 5HF.

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.

Submit Form