Shafton Lane Surgery - Online Services
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Patient Details
Change of home telephone or mobile number
Change of address
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Form Instructions

 

Patient Details:

Please enter your first name, last name and date of birth into these fields.

 

Change of Home Telephone / Mobile No:

If your home telephone or mobile number has changed enter the old and new values here. If either of these have not changed simply leave the fields blank. If you do not know your old number just leave it blank – Your current number is the important one.

 

Change of Address:

If you have moved address, please enter your old address and new address in the fields supplied.

 

Are my details secure ?

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible.

We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. When you submit your information, it is safely transmitted over the web in an encrypted form and deciphered using the private key at its intended location.

 

Other Notes:

All fields marked with * are mandatory.

 
 
 
 
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