Change of Contact Details

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Personal Details

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May be used to identify you

I wish to inform the practice of: *

Change of Name

Apologies

We can no longer process a change of name via this online form. Change of Name forms must be completed in person at the surgery with appropriate documentation provided. eg. Marriage Certificate

Change of Address

Please note we will require one form per patient moving. If there are multiple patients moving from your household they will also need to complete a change of address form. You may be asked to provide proof of your new address.

Change of Phone Number

May we use this number to contact you by text with appointment reminders?: *

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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Contact Details

Moatfield Surgery
St Michael's Road
East Grinstead
West Sussex
RH19 3GW

Telephone: 01342 327 555
Email:
sxicb-wsx.moatfield.surgery@nhs.net

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