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Patient Information

Update Contact Details

If these details are incorrect or out of date, complete the following form to update your GP surgery.

This form allows you to update your contact details and those of your household.

First name(s)*
Surname*
Date of birth*
DD slash MM slash YYYY
NHS Number
NHS number should be in the form nnn-nnn-nnnn for example: 123-456-7890
What would you like to change?*
- Name
- Address
- Phone Number
- Gender
New First Name
New Surname
New Address
Street Address Address Line 2 City ZIP / Postal Code
New Telephone Number
Gender Change
Other Family Details
Name 1
First Last
Date of birth 1
DD slash MM slash YYYY
Name 2
First Last
Date of birth 2
DD slash MM slash YYYY
Name 3
First Last
Date of birth 3
DD slash MM slash YYYY
Name 4
First Last
Date of birth 4
DD slash MM slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Date published: 12 June 2023
Date last updated: 12 June 2023

Contact Details

Phone: 0113 467 7500

Email: bhmp@nhs.net

Helpful links:

Leeds CCG
NHS Choices
CQC
Leeds St James’s
Leeds General Infirmary

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