Change of Name, Address or details – Overdale Medical Practice

If you are changing your Name you will need to provide proof. This can be a Deed poll, Valid Driving Licence, Valid Passport, Marriage Certificate, Birth Certificate or Decree Absolute. Please email this to the surgery via overdale.reception@nhs.net or alternatively bring a copy into the surgery.

Please check the practice boundary to ensure your new address is still within the practice area. If your new address falls outside the practice area you will need to register at an alternative GP practice. Visit Find a GP – NHS (www.nhs.uk)

Please complete the online form below or download the change of details form in PDF format

Change of Name or Address

Personal Details

Title

Full Name

Date of Birth

NHS Number

I wish to inform the practice of:

Change of Name

Change of Address

Change of Telephone Number

Change of Email Address

Previous Full Name

New Full Name

Title

Important information

If you are changing your name you will need to provide a copy of legal documentation showing your new name. This can be Deed poll, Valid driving Licence, Valid Passport, Marriage Certificate, Birth Certificate or Decree absolute. Please email this to the surgery via overdale.reception@nhs.net or alternatively bring a copy into the surgery.

New Address

Address Line 1

Address Line 2

City

Postcode

Previous Address

Address Line 1

Address Line 2

City

Postcode

List any other registered family members moving with you:

New Mobile Phone Number

New Landline Number:

New Alternative Number

Do you consent to the practice contacting you by text message?

Yes

New Email Address

Do you consent to the practice contacting you via email?

Yes