Woodstock Medical Centre

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Change of Contact Details

Please keep us up to date with any changes to your address, name or contact details.

Change of Personal Details

First Name *

Present Last Name *

Email *

Enter Email

Confirm Email *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

I wish to inform the practice of: *

Change of Name

Change of Address

Change of Phone Number

Change of Email Address

Change of Name

Previous Last Name *

If your name changed due to Marriage or by Deed Poll please provide the practice with a copy of the appropriate documentation

How do you wish to be known? *

Mrs

Miss

OtherOther

Change of Address

New address, including postcode *

Previous address, including postcode

List any other family members, listed with the practice, moving with you

New Phone Number

New phone number *

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

Yes

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. 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.

If you are human, leave this field blank.

About us

Our Practice
Our Clinics & Services
Our Team
Our Practice Policies

Essentials

Appointments
Repeat prescriptions
Patient registration

Contact Us

01555 665522
Out of hours: 111
Email the practice

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Woodstock Medical Centre
Woodstock Road, Lanark ML11 7DH

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