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You can use this form to request an update to the details listed on the primary care service provider contact details page.
Only Registration Authority (RA) Managers can use this form. If you use this form to ask for help with your smartcard, it will be rejected. For help with unlocking a smartcard or logging in, you'll need to find your Registration Authority.
Completing this form
Give as much detail as you can in the 'Requested change' section, including any changes of:
- named contact or RA provider
- address
- telephone
- website
- RA provider
Required form fields
Fields marked with an asterisk (*) need to be completed before the form can be submitted.
Form submitted successfully
We will get in touch with you by email if we need more detail.