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LGBTQ+ Details Amendment Form

Please use the form below to amend any changes to your personal details, including your name and gender marker. Please be aware that should you change your gender marker, you will be issued with a new NHS number and be registered as a new patient at your current practice with a new medical record created for you. This will be completed within 5 working days of receiving your request to ensure continuity of care. Please speak to a member of our team for more information.

LGBTQ+ details amendment
Please use format day/month/year e.g. 12/05/1979

LGBTQ+ details

Which of the following best describes you?
Is your gender identity the same as the gender you were given at birth?
Which of the following options best describes you?

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.