Furlong Medical Centre

01782 577388

Change personal details

Please let us know as soon as possible if you change your address, telephone number or name. It is important that we have up to date contact details in case we need to contact you.

Please note: 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).

  • Date Format: DD slash MM slash YYYY
    When would you like us to update our records?
  • NHS number should be in the form nnn-nnn-nnnn for example: 123-456-7890
  • Other members of your family requiring a change of address (if registered here)
  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.