Change of GP Request Form

Please complete the following form to request a change of GP within the practice.

Before you submit this form, please bear the following information in mind:

• If you are requesting to be transferred to a specific GP's patient list, please be aware that this is only possible if that GP is not at full capacity – GP capitation is based on the number of sessions they are able to offer routine appointments for.

• We do not transfer patients specifically to male or female GP lists because of patient preference. All our GPs are fully trained in all areas of male/female health.

First name

Surname

Date of birth

Address (please ensure that you include your postcode)

Current GP

Date of request

Reason(s) for wanting to change GP (please provide as much detail as possible, or your request may not be considered).