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Change my Name?

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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.

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

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

*Please make sure all Mandatory fields have been completed
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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.

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