Update your details

Use this form to let us know about any updates to your contact details and information.

Please note that we require a personal email address.

Name

Patient ID number

Date of Birth

Personal email address

Mobile number

New home address

Checkbox

I accept that Queens Road Medical Practice (QRMP) will attempt to communicate with me regarding bookings, cancellations and reminders.

Checkbox family members

I understand that QRMP are not responsible for family members receiving these messages in cases of shared address.

Checkbox test results consent

Tick this box if you consent to test results (positive or negative) or other medical information being sent to your personal email address

I am human