Change of Contact Details

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It is important that we have up-to-date contact details for you, so we can let you know about screenings, vaccinations and appointment reminders. Details can be completed by a patient, parent or guardian. If you have changed your mobile number or email address recently, please complete all of the fields below, where we can amend your details securely.

All data submitted via this form will be handled in accordance with our data protection policy.

Personal Details
Please double check you've entered the correct email address
 
May be used to identify you
I wish to inform the practice of: *
Change of Name
If your name changed due to Marriage or by Deed Poll please provide the practice with a copy of the appropriate documentation
How do you wish to be known?:
Change of Address
Change of Phone Number
May we use this number to contact you by text with appointment reminders?: *

Privacy Consent

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Contact

Kings Park Surgery
St Clements Avenue
Off Gubbins Lane
Harold Wood
Essex
RM3 0FE

Telephone: 01708 202621

Part of Hurley Group

Providing NHS Services

Care Quality Commission
Rating: Good

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