Updating your details

To ensure effective communication and correspondence with our patients, Mountwood Surgery would like to encourage patients to provide their email addresses, or provide an opportunity for update if a patient has recently changed their mobile number or email address.

Currently our records indicate circa only 60% of patients have provided email addresses.

It will also assist Mountwood Surgery, if patients added their first/preferred language or if there is a need for an interpreter. We have limited access to interpreters, but with notice we can usually arrange for an interpreter to telephone in during your appointment.

If you require an interpreter when you see your doctor, please notify the receptionist when booking the appointment. Sharing that information now will assist the practice.

Changing your address:
To inform Mountwood Surgery of address changes for yourself and/or family members also registered at the practice download the change address form here.

Find your NHS number here
You do not need to know your NHS number to use complete this form, but it is useful to add it if you can.

Please complete the online form below.

Updating your details

Title

First name

Surname

Date of birth

Gender

NHS number

Which details would you like to change?

Home telephone number

Mobile telephone number

Email address

Your ethnic group / background

Language preference / interpreter requirements

Home telephone number

Please provide your old and new home telephone numbers in the boxes below:

Old home telephone number

New home telephone number

Mobile telephone number

Please provide your old and new mobile telephone numbers in the boxes below:

Old mobile telephone number

New mobile telephone number

Email address

Please provide your old and new email address in the boxes below:

Old email address

Confirm old email address

New email address

Confirm new email address

Your ethnic group/background

Choose one of the following:*Not stated should be used where you have been given the opportunity to state your ethnic category but choose not to

Language preference / Interpreter requirement

Your language preference

Is an interpreter required?

Do you consent to receive SMS text messages from the practice?

Do you consent to receive emails from the practice?

Not for urgent medical help

Yes, I understand this form is NOT for urgent medical help

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to The Mountwood Surgery • Rickmansworth Road, Northwood, Middlesex, HA6 2RG.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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