Request a non-urgent routine GP appointment

About the Patient’s Problem

What best describes the problem you are reporting?

New problem

Ongoing problem

Describe the problem. If the practice is already aware of this problem, please tell us what has changed. *

Have you tried anything to help with this problem already? *

For example, self help, over the counter medication, pharmacy etc.

Is there anything specific that you were hoping to get from contacting us today? *

For example, GP review, treatment, a referral for further care, medication review, nurse appointment etc.

Is there a specific clinician you would prefer to deal with your query? *

We cannot guarantee that your query will be passed onto the clinician you have requested as this is dependent on their availability.

Are there any times when you are not available if someone needs to contact you? *

Please note, if a phone call is needed, the clinician will try to call you twice. If you miss both of these calls, you’ll need to fill in another form.

What is your preferred method of contact? *

Phone call

Text message (SMS)

Do you have any mobility issues that would require you to have an appointment on the ground floor?

Yes

This is to ensure we do not book you an appointment upstairs.

Do you need an interpreter?

Yes

Terms & Conditions *

I confirm that this problem is not an emergency. I understand that the practice will not deal with this problem while the practice is closed.

If the problem worsens and may require immediate help, I will visit NHS 111 Online or call 111. In an emergency I will call 999.

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Request a non-urgent routine GP appointment

About the Patient’s Problem