Request to change GP

We do try and allow patients to register with their preferred GP of choice. Unfortunately this isn’t always possible as some GPs have lists which are over subscribed.

If you wish to change GPs complete the form below and we will happily look into your request.

Change of GP request form

Name*
First Last
Address*
Street Address Address Line 2 City/Town County Post code Country
Date of birth*
DD slash MM slash YYYY
Please select your current GP*
Please select you preferred new GP*
Email
Enter Email Confirm Email
We will email you with the outcome of your request. If you do not have an email address we will notify you by post.
Consent*
Please note that no medical information or questions will be responded to. The data you supply on this form will be stored on our website, which is hosted by a third party, until it has been processed by the practice. The data will be used lawfully, in accordance with the Data Protection Act 2018, which gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly. The practice privacy policy can be viewed on this website.
I agree to the privacy policy.
Signature*
Date*
DD slash MM slash YYYY

Change of GP request form

Helpful links

Further Info