788-792 Whalley New Road, Blackburn, Lancashire, BB1 9BA

Tel: 01254 247 477

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Change Your Contact Details

Please use this form to tell us if you are moving. This form can also be used to let us know if you have changed any other details.

Personal Details

Full name: If moving, household members moving with you: If moving, date you are moving: If moving, old Address: If moving, old Postcode: If moving, new Address: If moving, new Postcode: Old Telephone Number: New Telephone Number: Old Mobile Number: New Mobile Number: Old Email Address: New Email Address:

Confirm Your Location

I confirm that I am a patient at Brownhill Surgery, Blackburn, Lancashire.

Information provided by you through this form will allow us to improve our services. The form data undergoes encryption during transmission and while at rest, and will only be retained for a duration sufficient to process your request. You have the option to withdraw your request at any time by notifying the practice. By using this form you are agreeing to our privacy guidelines.

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