Change your contact details

What contact information needs updating? (Required)*
- Name
- Phone number
- Address
- Doctor (GP)
Select at least one option: Name, Phone number, Address and/or Doctor (GP), so that all the correct form fields are available to be completed. This is required* the form cannot be submitted without selecting one of the boxes.
Current Name (Required)*
First names Last name
Enter all of your current names. This is required*, the form cannot be submitted without entering your first and last names.
Were you known by another name?
- Yes
- No
If you were you known to us by another name please tell us your former name.
Other names previously known by (Required)*
First names Last name
If you were you known to us by another name please tell us the names you were previously known by.
NHI Number

Your NHI (National Health Index) Number is a unique number given to every patient, it is usually found on all appointment letters and consists of 3 letters and 4 numbers.
Date of birth (Required)*
DD slash MM slash YYYY

Enter your date of birth. This is required, the form cannot be submitted without entering this information.
Current Postal Address (Required)*
Street Address City Postcode Country

Enter your new postal address to be used for correspondence with Canterbury DHB. All fields need to be completed and are required *, the form cannot be submitted without entering information into all address fields.
Old Postal Address (Required)*
Street Address City Postcode Country

Enter your former postal address. Providing your old address helps us find your records on our system.
Current Phone Number (Required)*
Mobile or Landline
Enter at least one phone number to use if we need to contact you. This is required, the form cannot be submitted without entering this information.
Old Phone Number (Required)*
Mobile or Landline
The name of your current doctor and GP practice (Required)*

Let us know the name of your doctor (GP) and your GP Practice so that we can update their records if necessary.
The name of your old doctor and GP practice (Required)*

Let us know the name of your former doctor (GP) and your former GP Practice, this helps us to update your health record.
Email Address
Enter Email Confirm Email

Please provide your contact email address if you have one.
Would you like a confirmation email when your contact details have been updated?
- Yes (Note: You must enter an email address above)
- No
Note: You must provide an email address if you would like a confirmation email.
Add more people

Current Name (Required) Actions

There are no people.

Maximum number of people reached.

Optionally add more people in your family or household to this request.
Comments
You can let us know any additional helpful information about these contact changes, but please use our other Enquiry form for enquiries about other services.
Please check all details are correct before submitting this form.
Phone
This field is for validation purposes and should be left unchanged.

Current Name (Required)	Actions
There are no people.

Is this page useful?
- Yes
- No
What worked well for you?
Please note: Information submitted from this form is only used for the purpose of improving this website, the form is not regularly monitored. For all enquiries and feedback (including complaints, suggestions and compliments) about Te Whatu Ora - Waitaha Canterbury health services, please use the Enquiries and Feedback Form We cannot respond to requests for medical advice, please contact your family doctor, specialist medical professional, or call healthline on 0800 611 116.
Something is broken or outdated
Please note: Information submitted from this form is only used for the purpose of improving this website, the form is not regularly monitored. For all enquiries and feedback (including complaints, suggestions and compliments) about Te Whatu Ora - Waitaha Canterbury health services, please use the Enquiries and Feedback Form We cannot respond to requests for medical advice, please contact your family doctor, specialist medical professional, or call healthline on 0800 611 116.
Email (Optional)
Note: The Send button will display once you've entered some information.
Phone
This field is for validation purposes and should be left unchanged.

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