Request a routine appointment

About the Patient’s Problem

Please tell us about the problem, providing as much information as you can. If the practice is already aware of this problem, please tell us what has changed.

How long has this been a problem?

If you’re not sure, it’s helpful to tell us whether it’s been days, weeks, months or years.

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)

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

Video Consultation:

I am willing to accept a 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.

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 – Please select both boxes before submitting

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.

If you think it would be helpful, please upload photo(s) of your condition.

Maximum upload size: 67.11MB

Tell us whether you accept cookies

Request a routine appointment

About the Patient’s Problem