GP Web Solutions – Theme Change

GP Web Solutions Theme Change

Please fill in this form so that we have the information required to transfer your practice onto our new website theme.

Practice Name *

Please enter your practice name here

CDB Number *

Please enter your EMIS/Egton Account (CDB) Number

Practice Contact Name *

Please provide the name of your Site Contact

Practice Contact Email *

Please provide the email address of your Site Contact

Current Web Address *

Please specify the web address of your current website

EMIS Now Case Number (Optional)

Please provide the case reference number for this change if you have been provided one.

Clinical System Provider * Clinical System Provider

Are the contact details (Address and Phone Number(s)) correct on your current website? *

Yes

Contact Number *

Please provide the correct phone number

Fax Number (Optional)

Please provide the correct fax number (if applicable)

Surgery Address *

Surgery Address

Zip/Postal

City

Country