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Milton Road: 01375 807130
The Grays Surgery: 01375 390717
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Looking After Someone – Information And Support For Carers
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Menu
Home
About Us
Contact
Have your Say
Making the most of your Practice
Meet the Team
Partners
Doctors
Nurses
Physician Asistants
Practice Team
Our Allied Health Professionals
Opening Hours
What to do when we are closed
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Website
LGBTQ+ Aware
Cervical screening for trans men and/or non-binary people
LGBTQ+ Aware Practice – Equity for ALL
Change Your Gender Marker
Regulations & Governance
Teenage Friendly
Learning Disability
Sharing information about your support needs
Reasonable Adjustments
Learning Disability Mission Statement
Clinics & Services
Appointments, Tests & Referrals
Appointments
Know Who to Turn to for Your Healthcare
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Travel Clinic & Holiday Vaccinations
Online Services
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Help & Support
Immunisations for Migrants and Overseas Visitors
Carers Hub
Carers Guide: Introduction to sepsis and serious illness
Carers Guide: Soft signs of being unwell
Carers – please contact the practice and let us know
Patients registered as a Carer
Top tips to get the most out of your GP appointment
Information from NHS UK on Carers and Caring
Looking After Someone – Information And Support For Carers
Support for Young Carers
Services for carers
News
Milton Road and The Grays Surgery
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Change of Contact Details Form
Change of Contact Details Form
Change of Personal Details
First Name
*
Present Last Name
*
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?
*
Dr
Mr
Mrs
Miss
Ms
Other
Other
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
No
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.
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Home
About Us
Contact
Have your Say
Making the most of your Practice
Meet the Team
Partners
Doctors
Nurses
Physician Asistants
Practice Team
Our Allied Health Professionals
Opening Hours
What to do when we are closed
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Website
LGBTQ+ Aware
Cervical screening for trans men and/or non-binary people
LGBTQ+ Aware Practice – Equity for ALL
Change Your Gender Marker
Regulations & Governance
Teenage Friendly
Learning Disability
Sharing information about your support needs
Reasonable Adjustments
Learning Disability Mission Statement
Clinics & Services
Appointments, Tests & Referrals
Appointments
Know Who to Turn to for Your Healthcare
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Travel Clinic & Holiday Vaccinations
Online Services
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Help & Support
Immunisations for Migrants and Overseas Visitors
Carers Hub
Carers Guide: Introduction to sepsis and serious illness
Carers Guide: Soft signs of being unwell
Carers – please contact the practice and let us know
Patients registered as a Carer
Top tips to get the most out of your GP appointment
Information from NHS UK on Carers and Caring
Looking After Someone – Information And Support For Carers
Support for Young Carers
Services for carers
News