Change of Personal Details

You can use this form to tell us about a change of address, or a change of telephone number or email address.

If you have moved outside of Crawley or Horley, we will not be able to accept the new address, and you will need to register with a new GP surgery close to your new home.

If you need to change your name, please visit or email the practice, including a copy of a marriage certificate or deed poll.

Last Updated: 10/05/2023

Your Details

Full name *

Date of Birth *

Current Email Address *

Change of Address

If you need to update the address of any children who live with you, you can include their details here. Adults living with you will need to submit their own form.

New Address, Including Postcode

Previous Address, Including Postcode

Please list all family members under 18 moving with you. All adults will need to submit their own form.

Update Contact Details

New Number

Number Type

Please list any telephone numbers that need removing from your medical record

New email address

Do your old telephone number or email address appear on anyone else's medical records, e.g. children or people you care for? If so, please list them here.

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. The information on this form will be stored in our website provided by My Surgery Website for up to one month before being deleted. 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.

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Change of Personal Details

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