Update primary care service provider contact details

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
• email
• telephone
• website
• RA provider

Required form fields

Fields marked with an asterisk (*) need to be completed before the form can be submitted.