Change Personal Details

Please let us know as soon as possible if you change your address, telephone number or name. It is important that we have up to date contact details in case we need to contact you.

Please note: If your name has changed due to Marriage or by Deed Poll, can you please provide us with a copy of the appropriate document (requirement of Department of Health).

KAMP can dispense medications to patients living more than a mile from their closest chemist or pharmacy. If you move house to meet this criteria, you can chose to collect medications directly from KAMP.

If you have previously been a dispensing patient and you move to be within one mile of a pharmacy, we can no longer legally dispense to you and you will need to nominate a local pharmacy to collect from.

Change of name or address

Change of name or address

If you are human, leave this field blank.

About you

Present Surname: *

Forename: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Email Address: *

Please select the information you are wanting to update?

Name

Address

Contact Numbers

Change of Name

Previous Surname: *

If your name has changed due to Marriage or by Deed Poll, can you please provide us with a copy of the appropriate document (requirement of Department of Health).

How do you wish to be known? *

Dr

Mr

Mrs

Miss

Ms

OtherOther

Change of Address

New address, including postcode: *

Previous address:

Please list all family members moving with you:

Only if they are registered at this practice.

Update Contact Numbers

Would you have any objection to being reminded by text for appointments?

Yes

No

New telephone number: