Update your contact details For gender identity clinic patients Step 1 of 5 20% Before you startYou can use this form to update the information we hold about you. Completing this form will ensure that you receive communications about your treatment by the method you choose. This form is only for patients of our gender identity clinic. If you are a patient of another service, use this form. About youYour name(Required) First Last Your preferred nameIf different than above First Last Your date of birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your NHS numberYour previous NHS numberIf applicable Your address(Required) Street Address Address Line 2 City Post code Your mobile number(Required)Your home phone numberYour email(Required) Your preferencesAre you happy to receive secure email?(Required)Find out what this means (will open in a new window) Yes No Are you happy to receive messages via our patient portal?(Required)Find out what this means (will open in a new window) Yes No How do you want to receiving information relating to your care Secure email Text message Post Calls to your mobile Calls to your home phone Leaving voice mail on your mobile Leaving voice mail on your home phone How do you want to receiving information regarding outcome monitoring Secure email Text message Post Calls to your mobile Calls to your home phone Leaving voice mail on your mobile Leaving voice mail on your home phone How do you want to receiving information regarding patient and public involvement Secure email Text message Post Calls to your mobile Calls to your home phone Leaving voice mail on your mobile Leaving voice mail on your home phone Your GP detailsYour GP's name(Required) First Last Your GP's address(Required) Street Address Address Line 2 City Post code Your GP's phone number(Required)Your GP's email Contacting your GP We normally write to and update your GP and the person that referred you to our service. Tick this box if you do not wish us to contact your GP.
