Changes in Personal Information

Please advise us promptly of any changes in your name, address or contact telehone number so that records may be updated. This information is essential if home visits are required. It is also very helpful to have contact telephone numbers included in your records. This is particularly relevant if your number is ex-directory. Please be assured that the information given is totally confidential and not passed on to others except for hospital appointments.

Update your Details

Name*
First Last
Date of Birth*
Sex*
- Male
- Female
Please only fill in relevant changes
New Surname
Date of Change
MM slash DD slash YYYY
Old Address
Old Home Tel
New Address
New Home Tel
Old Email
New Email
Old Mobile Number
New Mobile Number
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Privacy*
- By using this form you agree with the storage and handling of your data by this website. *
Phone
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Friends and Family Test

We would like you to think about your recent experiences of our service.
How likely are you to recommend our GP practice to friends and family if they needed similar care or treatment?*
- Extremely likely
- Likely
- Neither likely nor unlikely
- Unlikely
- Extremely Unlikely
- Don't know
We want you to have the best possible experience of care. The NHS Friends and Family Test is a way of gathering your feedback, so we can continually review our service. Your feedback will help us learn more about what you think of your experience – what you like and what you think we could improve. Ultimately, you’re helping us to make changes that will ensure we can offer the best possible care.
Do you think the practice has improved in the last 12 months?
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Comments
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The Park Surgery

Changes in Personal Information