Request a Non-Urgent GP Appointment

Please complete the form below to request a non-urgent GP appointment.

This form is for pre-bookable doctor appointments only. For non-clinical requests, please visit our Admin Queries page.

Visit Admin Queries

Check it is not an emergency

This form is not monitored immediately. If you need urgent medical help, please call 111 or 999.

Call NHS 111 Call 999 in an emergency

Call 111 or 999 if you have any of these symptoms

Crushing chest pain or tightness
New drooping on one side of the face, slurred speech, difficulty raising your arms, weakness or numbness on one side of your body
Severe difficulty breathing
Heavy bleeding that will not stop
Severe injuries
Feeling suicidal, wanting to harm yourself, or wanting to harm others

Patient details

Is this request submitted for yourself or for someone you care for? Please note the practice must have received written consent to discuss any patient medical needs who are over the age of 18+

On behalf of myself
On behalf of my child
On behalf of someone I care for and confirm the practice already has written consent for this.

Patients First Name

Patients Last Name

Date of birth

Postcode

Your phone number. A mobile number is preferred

Medical issue details

Please describe the medical problem. If you are filling this in on behalf of someone else, please make that clear

Attach a photo (Optional)

How long have these symptoms or concerns been going on? Have they got better or worse?

Is there anything you are particularly worried about? (Optional)

How would you like us to help?

Please enter any times during opening hours when we cannot contact you (Optional). We will only contact you within practice opening hours

How would you prefer to be reviewed?

Telephone
Face to Face
Video Call