How Do I...

Change my Name?

Make an Appointment

Request an Appointment Online

Change of Name Form

Required fields are marked with an asterisk (*).

PLEASE NOTE – We do not have access to any Hospital records outside of our organisation, Please remember to update any Hospitals or other NHS services separately.

Title*

Name*

First

Surname*

Last

Patient Date of Birth*

House Name/Number*

Town*

Email address*

Telephone Number

Street*

Postcode*

Please tell us your name change Title + First Name + Surname

Title*

New Name (If applicable)*

First

New Surname (If applicable)*

Last

Teldoc will require you to upload a copy or photo of the official document that will allow us to formally change your details at the same time this form is submitted.

Evidence Upload*

*Evidence upload here… (We accept Deed poll or Marriage certificate, decree absolute ONLY )

*Please make sure all Mandatory fields have been completed

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data *

I consent to the practice collecting and storing my data from this form

Are you human?*

This field should be left blank

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Please note this Change of Name Form is not to be used for the following purposes:

Medical matters, Prescription requests, Patient Access requests, Appointment requests or Complaints. Medical matters cannot be dealt with via this form. If you have a query regarding a medical matter please telephone reception to make an appointment to see the appropriate person.

Other forms available

Register as Patient

Please visit our Patient Registration page and fill in the health questionnaire to register as a patient at Teldoc.

Change of Contact Details

Update your email, phone or mobile number

Change of Address

Please visit our Change of Name Form to update your details

Provide Feedback

Please visit our Feedback Form to provide feedback, make a suggestion or complaint.

More forms

Please visit the How Do I Portal for more forms

Find out more...

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All the latest news from Teldoc Primary Care Network, the NHS and other health services

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Vaccination Information

All the latest vaccination clinic dates and locations and latest vaccination news from Teldoc and NHS

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Visit the How Do I Portal

Visit the How Do I portal for information on how to make an appointment, register at the practice and change your details