Change of Personal Details

If you have changed any personal details recently such as your telephone number, address, mobile number, name (If you just got married) then please let us know by completing the change of details form below.

Please note that if you move and your new address falls outside the lines of our catchment area, regardless of your new postcode, you will be asked to register with another GP closer to your new address.

Name

Date Of Birth

Health Visitor to be advised Of Under 5’s

New Address

Other Patients At Same Address. Provide name and date of birth for each patient.

Date Of Moving

New Telephone No

Next Of Kin Name

Next Of Kin relationship to you

Next of Kin Telephone No

Smear Card Amended

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 and is accessed over a secure connection by nominated staff. We have 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 Leander Family Practice • 949 London Road, Thornton Heath, Surrey, CR7 6JE.

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.