Pre-Bookable Appointment Request Form

Please use this form at any time to get help from your practice. We aim to respond within 2 working days.

If you feel that your issue is more urgent, please contact the surgery on 01842 753115.

Same Day - Get help for any health problem

Section

Is this your up to date telephone number? *

About the Patient's Problem

If you're not sure, it's helpful to tell us whether it's been days, weeks, months or years.
How would you like us to deal with the problem? *
We will reply in the first instance and wherever possible by email as this preference cannot always be accommodated.

Online message sent through your email

Telephone

Face to face appointment

Video Consultation:

Video consultations require you to have a smartphone, tablet, laptop or any computer with camera and microphone or headset. You will also require access to the internet, preferably over WiFi. If the practice decides on a video consultation you will be sent an email containing a link for the video consultation, so it's best if you can receive your emails on that same device.

Pharmacy Referral

The on call GP may decide your request can be dealt with by your pharmacist with a face to face appointment. This could reduce the time your request is dealt with as these are usually dealt with within an hour.

Are you happy for us to do a Community Pharmacy referral if the GP deems it appropriate? *
Please select from the following pharmacies that provide this service: *

Do you require a translator?
This is not guaranteed but we will always try book with them if possible.
The practice can send a text message to your phone with your appointment time. *
Terms & Conditions *
If you think it would be helpful, please upload photo(s) of your condition.
Drop a file here or click to upload Choose File
Maximum upload size: 20.97MB