Request an appointment with a doctor

This form is not for urgent requests or on the day appointments. Please contact us via 01827 217799 if you require an appointment the same day or within 48 hours.

About the Patient’s Problem

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

If this is an ongoing issue, which clinician have you been discussing your issue with? *

Do you have any ideas about what is causing the problem? *

What are the concerns? *

How would you like us to help? *

How would you like us to deal with the problem? *

Online message sent through your email

Telephone consult

Face to face appointment

Online message sent through your email

We might still need to phone you or arrange a face to face appointment. Please tell us if either of these would be a problem for you:

Telephone

Are there any times when you would not be free for an appointment?

We might still need to send you a secure online message or arrange a face to face appointment. Please tell us if either of these would be a problem for you:

Face to face appointment

Are there any times when you would not be free for an appointment?

Our doctors will decide whether an appointment is the best way to help you. We might need to send you a secure online message or phone you. Please tell us if either of these would be a problem for you:

After submitting an appointment request, please do not call the practice to follow up. Your request will be triaged by a clinician within 48 working hours. You will receive a response with the appropriate clinical advice, or an appointment if required.

The practice can send a text message to your phone with your appointment time. *

I agree to the practice sending me text messages including appointment times

I do not agree to the practice sending me a text message with my appointment time

Terms & Conditions *

It is my responsibility to check for a response from the practice regarding my request, I am aware this may go to junk/spam folder.

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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About the Patient’s Problem

Online message sent through your email

Telephone

Face to face appointment