Update your next of kin – Rivermead Gate Medical Centre

If you would like to update your next of kin details please use the online form below.

Your name(Required)

First Last

Your date of birth(Required)

Your home phone number(Required)

Your mobile phone number(Required)

Your email address

Enter Email Confirm Email

Next of kin name(Required)

First Last

Relationship to you(Required)

Next of kin address(Required)

Next of kin home phone number(Required)

Next of kin mobile phone number(Required)

Can we contact your next of kin in an emergency?(Required)

Yes

Can we discuss your medical record with your next of kin?(Required)

Yes

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help

Comments

This field is for validation purposes and should be left unchanged.