Change of Patient Details Surname First name(s) Your date of birth NHS No. An NHS number is a 10-digit number, like 485 777 3456. If known, please enter your NHS number in the field below. You can find more information on the NHS website Previous address (if applicable) Current home address (please note if you are outside our area you will be asked to register elsewhere) Previous contact number New contact number Previous email address New email address Reason for change Please briefly describe the reason for changing your contact details I confirm that the information provided is accurate, and I authorise the NHS to update my contact details Signature Please write your full name to sign the form The date of submitting the application