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
CAPTCHA
Privacy*
- By using this form you agree with the storage and handling of your data by this website. *
Phone
This field is for validation purposes and should be left unchanged.

Friends and Family Test

We would like you to think about your recent experiences of our service.
Thinking about your recent visit, overall, how was your experience of our service?*
- Very good
- Good
- Neither good nor poor
- Poor
- Very poor
- 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.
Please can you tell us why you gave your answer?
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

This website uses cookies to improve your user experience. If you continue on this website, you will be providing your consent to our use of cookies.

More information Close Accept

The Park Surgery

Changes in Personal Information