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Kennedy Way SurgeryBristol, North Somerset and South Gloucestershire ICB

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Update your Details

To update details like your name, address, phone numbers or email address, use the change of details form below.

Step 1 of 6

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What is your current full name? Required

What is your date of birth? Required

Day

Month

Year

Your NHS number (if known) Optional

Do you want to update your name? Required

Yes

What is your new full name? Required

Proof of change of name Requiredi.e. marriage/divorce document, deed poll evidence

Accepted file types: jpg, jpeg, pdf, png, bmp, doc, doc, gif, Max. file size: 10 MB.

Do you want to update your address? Required

Yes

Your previous address Required

Street Address Address Line 2 Town County Postcode

Your new address Required

Street Address Address Line 2 Town County Postcode

Do you want to update your contact details? Required

Yes

New mobile number Required

New landline number (if applicable) Optional

Email address Required

What is your smoking status? Required

Non smoker

Ex-smoker

Current smoker

I use a vape device

Roughly when did you stop smoking? Required

How many do you smoke per day? Required

Are you interested in stopping smoking? Required

Yes

You can read more about stopping smoking on the NHS.uk website.

NHS stop smoking services (opens in new tab)

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