Telephone Appointment Request

    • 1


    • 2

      Response Time Info

    • 3

      Patient Details

    • 4


    • 5

      Associated Conditions

    • 6

      Ideas & Concerns

    • 7

      Further Details

    • 8



    Check it’s not an emergency

    Call 999 now if you have:

    • signs of a heart attack - pain like a very tight band, heavyweight or squeezing in the centre of your chest
    • signs of a stroke - face drooping on one side, can’t hold both arms up, difficulty speaking
    • severe difficulty breathing - gasping, not being able to get words out, choking or lips turning blue
    • heavy bleeding - that won’t stop
    • severe injuries - or deep cuts after a serious accident
    • seizure (fit) - someone is shaking or jerking because of a fit, or is unconscious (can’t be woken up)
    • sudden, rapid swelling - of the eyes, lips, mouth, throat or tongue

    I confirm that I have none of these.

    This service is only for non-emergency/non urgent cases and available to patients registered at this practice. Please note that after submitting the online consultation request, your GP Practice will assess your symptoms and will contact you as soon as possible, usually on the same or following day, and not more than 5 working days. If you think you need urgent attention, please phone your GP Practice directly.

    I confirm that I am registered with this practice.

    I understand it may take up to 5 working days to respond.

    Tell us about you, or the person you're asking about?

    What is your first name? (required)

    What is your surname? (required)

    What is your date of birth? (required)

    What is your email address?

    What is your phone number? (required)

    What can you tell us about your symptoms?

    Please describe your symptoms.

    How long ago did your symptoms start in days? (Enter 0 if your symptoms started today)

    What can you tell us about your symptoms?

    Does anything make your symptoms feel better?

    Does anything make your symptoms feel worse?

    What can you tell us about your symptoms?

    Are your symptoms associated with any other symptoms?

    What treatments have you tried already?

    What can you tell us about your symptoms?

    Do you have any idea what might be causing your symptoms?

    Is your symptom visible, for example a skin condition that you would like your doctor to see? If yes you may upload a good quality image here.

    Do you have any concerns about your symptoms?

    What are your expectations of this assessment?