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Victoria and Five Elms Medical Centre NHS GP surgeries in Essex and Dagenham

Change your personal details

Change your personal details

Required fields are labelled

What is your name? Required

First name

Last name

What is your date of birth? Required

For example, 31 3 1980

Day

Month

Year

What is your sex? Required

As recorded on your medical record

Male

Female

Other

What is your postcode? Required

The one used to register with your GP

What is your phone number? Required

What is your email address? Required

Anyone else with access to your email account may see responses sent to you

Which surgery are you registered at? Required

Victoria Medical Centre

Five Elms Medical Practice

Which contact details would you like to change?

Name

Address

Contact number

Change of Name

Previous Surname: Required

How do you wish to be known? Required

Dr

Mr

Mrs

Miss

Ms

Other

Other: Required

Change of Address

New address, including postcode: Required

Previous address: Required

Please list all family members moving with you:

Only if they are registered at this practice.

Update Contact Numbers

New telephone number: Required

To complete the request, you can upload a copy of any relevant documents. For example, a marriage certificate or proof of new address.

Do not upload sensitive photographs of genitalia, bottoms (anus), breasts or minors without asking a healthcare professional first. Your uploads may be stored on your health record.

If you are human, leave this field blank.

Forms Unavailable

Our forms are currently closed. For medical assistance, please call NHS 111, or contact them online using the button below.

For medical emergencies only, please call 999

Victoria Medical Centre
1 Queens Road
Barking
Essex
IG11 8GD

Get directions

020 8477 8760

Five Elms Medical Practice
Five Elms Road
Dagenham
RM9 5TT

Get directions

0208 517 1175

About the surgery

Register with the surgery

Sick (fit) notes

Feedback and complaints

This service is no longer registered with CQC

View this service's archived profile on the CQC website

Five Elms Medical Practice

CQC overall rating

Requires improvement

14 April 2020

See the report

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