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 this? (Optional)

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

Online message sent through email

Telephone

Video consultation

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:

Are there any days/times when you would not be available to receive a phone call?

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.

How quickly do you think the matter needs to be dealt with? *

Same day

Routine

Please note this request will be triaged by a GP.

You will receive a text or email message confirming your appointment details.

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.

Please upload any relevant evidence in relation to your health matter.

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About the Patient’s Problem