Change Your Contact Details - Millbrook Medical Centre

Change Your Address

Change Your Phone Number

Please complete the online form below if you wish to inform the practice of a change to your phone number. Unfortunately we cannot accept change of name online.

Title

First Name

Surname

Previous Surname Optional

Date of Birth

Place of Birth

Email

Enter Email Optional Confirm Email Optional

Previous Home Number

Previous Mobile Number

Current Home Number

Current Mobile Number

Would you like to receive text message reminders?

Yes

No

Change Your Name

If you wish to change your name, you must present at Reception with a legal form of ID (Passport, Driving License or Deed Poll) and complete our form. We are unable to accept Marriage Certificates as an official form of documentation for a name change.