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Home > Change of Address/Personal Details

Change of Address/Personal Details

If you are using this form to change your name, we do require photographic evidence of when and why this was changed. We cannot action a change of name without this. Please complete the form and then send a copy of your documents to hnyicb-ery.bmgreception@nhs.net

Previous Details
Including Title
This will allow us to locate you quickly on our Patient Database.
Previous Address
Previous Contact Details
New Details

Provide details where different to previous.

Including Title
DD/MM/YYYY
This will allow us to locate you quickly on our Patient Database.
New Address
New Contact Details
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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Main Surgery

Goole Health Centre, Woodland Avenue, Goole, DN14 6RU

  • 01405 767711

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Alfreds Place, Swinefleet Road, Goole, DN14 5RL

  • 01405 767711
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Local Services
Optician
Funeral
Plans
Double
Glazing
Footcare