Change of Details/Address

Please contact the Surgery via the form below to let us know of any changes of your personal details such as name, address and phone number.

Please be advised if you have moved out of our practice boundary, you will be asked to find a new GP.

Title

Mrs

Miss

Other

First Name

Surname

Previous Surname Optional

Date of Birth

DD slash MM slash YYYY

Place of Birth

Enter Email Optional Confirm Email Optional

Current Home Number Optional

Current Mobile Number Optional

Would you like to receive text message reminders?

Yes

Are you a student?

Yes

Where are you a student at?

Previous Address

Street Address Address Line 2 City Postcode Country

Current Address

Street Address Address Line 2 City Postcode Country

Other members of your family requiring a change of address (if registered here)

Name

Date of Birth

Greenridge Primary Care Centre

671 Yardley Wood Road,
Billesley,
Birmingham,
B13 0HN

Mo,We 7:30 am – 6:30 pm; Tu,Th,Fr 8:00 am – 6:30 pm