Updating your details – Dorema Surgery

If you change name, address or telephone number, please let our receptionists know by calling, writing to us or filling out the below form. If you move outside the practice boundary 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.

Update contact details

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

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/CHI Number (if known)
NHS/CHI number should be in the form nnn-nnn-nnnn for example:
Sex*
- Male
- Female
Old address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code
Old telephone number
New address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code
New telephone number
Other members of your family requiring a change of address (if registered here)
Name 1
First Last
Date of birth 1
DD slash MM slash YYYY
Name 2
First Last
Date of birth 2
DD slash MM slash YYYY
Name 3
First Last
Date of birth 3
DD slash MM slash YYYY
Name 4
First Last
Date of birth 4
DD slash MM slash YYYY
Comments
This field is for validation purposes and should be left unchanged.