Change my Personal Details

Your Name (required)
Your Date of Birth (required)
Your Email (include if you would like a copy of your details)
Please specify any changes to your details below
New Surname:
New HOME phone number: Permission to leave voicemail message?  Yes No
New WORK phone number: Permission to leave voicemail message?  Yes No
New MOBILE phone number: Permission to leave voicemail message?  Yes No
New EMAIL address:
New HOME address
Other members of the family (name & dob) to be changed as well:

Please note: While we do everything possible within the practice to ensure your information is secure, this website is outwith the NHS Lothian network and no transmission over the Internet can be guaranteed to be 100% secure. Therefore, you provide us with your information at your own risk.

Did you know?

Cold and flu viruses can survive on hard surfaces such as phones and hand rails for some time. Regular, effective hand washing can reduce your chances of infection significantly. For further information visit: http://www.washyourhandsofthem.com
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