Change of contact number for 18 year olds

Now that you have reached 18, we would like to contact you directly regarding your healthcare rather than your parent or guardian.

Please provide us with your own mobile number and email address so that we can update your records and keep your health information confidential.

Your Details

Surname *

Forename *

Date of Birth *

Email Address

By giving us your email address you are consenting to us using it to contact you. However, if you would like to opt out of receiving emails from the Practice, please select from the opt out option below.

I would like to opt out of receiving emails from the Practice about my healthcare

I would like to opt out of receiving emails from the Practice about Practice services or developments, such as practice closures and new practice information

Update Contact Numbers

Mobile Number *

By giving us your mobile number you are consenting to us using it to contact you. However, if you would like to opt out of receiving SMS messages from the Practice, please select from the opt out options below.

I would like to opt of receiving SMS appointment reminders and other messages about my healthcare

I would like to opt out of receiving SMS messages from Practice about Practice services or developments, such as practice closures and new practice information

Home Number

This form collects your name, date of birth, email, other personal information. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Page last reviewed: 24 April 2024
Page created: 24 April 2023

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Change of contact number for 18 year olds

Change of contact number for 18 year olds

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