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LOCKSIDE MEDICAL CENTRE

85 Huddersfield Road, Stalybridge SK15 2PT

Telephone: 0161 303 7200

We are open, Please follow the Green Tile (Request help including Appointments) on the Home page to fill out the online consultation form. Thank You

Facebook Link

Professionals contact link

Use this form if you are a health or social care professional (including care home staff) who needs to contact us about one of our patients

LinkedIn
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Name of patient*
First Last
Patient's date of birth*
DD slash MM slash YYYY
Your name*
First Last
Your mobile number*
We may need to phone you to clarify details of your request.
Your work email address*
Message*
Please only use this form if you are a health and care professional needing to contact the practice about one of our registered patients.

Lockside Medical Centre

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Name*

Prefix First Last

I would like to update my name.

Tick here for more options.

You do not need to provide a reason for this change, but an example could be marriage/divorce or changes made by deed poll.

New Name

Prefix First Middle Last

You do not need to provide a reason for this change, but an example could be marriage/divorce or changes made by deed poll.

Date of Birth*

Address (Current/Previous)*

Street Address Postcode Country

This should match the address we have on file for you.

TICK HERE*

My address remains the same.

I need to update my address.

New Address

Street Address Postcode Country

Please provide the Name & DOB of ANY members of your household that have moved to the same address.*

ONLY REQUIRED IF YOU ARE PROVIDING A CHANGE OF ADDRESS and family members are currently registered with us. Please note 'NA' if this is not applicable to you.

Phone (Current/Previous)*

Email (Current/Previous)*

TICK HERE*

My contact details remain the same.

I need to update my contact details.

New Phone Number

New Email*

Smoking Status*

How many a day?*

How often?*