Get help for any health problem

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. *

Do you have any ideas about what is causing the problem? (Optional)

What are the concerns? (Optional)

How would you like us to help? (Optional)

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

Telephone

Face to face 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:

Is there a member of staff who would be best to deal with this problem?

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 *

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.

I understand that this form is for non-urgent enquiries, and I may not receive a response from the practice within the same working day.

If I feel my enquiry requires a same day response, I will contact the practice directly on the phone or in person.

You may also upload images of your condition if needed.

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About the Patient’s Problem

Face to face appointment