Change Of Address Form

Please submit one form for each patient whose details need to be changed.

Whilst we can update your contact details in order to keep your GP records up-to-date, if you are currently under the care of any Hospital Consultant or Clinic, or are awaiting any Outpatient or Clinic appointments, it is very important that you contact Hospital or Service in order to inform them of your new contact details.

NLAG (Northern Lincolnshire & Goole Hospitals) – Goole / Scunthorpe / Grimsby – 03033 306999

H&EY (Hull & East Yorkshire Hospitals) – Hull Royal Infirmary / Castle Hill – 01482 604444

Please select the practice location most relevant to this Online Form submission:

Change Of Address Form

Full Name

Date of Birth

Previous Address

New Address

Home Tel No.

Mobile Tel No.

Email Confirmation

Tick the box if you would like to receive an e-mail confirming the form has been received by Bartholomew Medical Group.

Privacy Protection

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.

I consent to my information being used for the purposes described above and wish to submit this online form to Main Surgery • Goole Health Centre, Woodland Avenue, Goole, DN14 6RU.

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.