Get help for any health problem

Use this form at any time to get help from your practice. We aim to respond within 2 working days.

If you are human, leave this field blank.

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. *

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)

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

Telephone

Face to face appointment

Telephone

Are there any times today when you would not be free to receive a phone call? *

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 today 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:

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

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

Tomorrow at the latest

It can wait a few days

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.

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