Get help for any health problem

Use this form at any time to get help from your practice. We aim to respond within 4 working hours.

Clinically urgent requests submitted up until 18:30 will be dealt with the same day, while non-urgent requests submitted after 16:30 will be dealt with the next working day.

Please be aware that this form is for both GP and Nurse Practitioner appointments.

Replies from the surgery may appear in your Junk Inbox.

Get help for any health problem

Get help for any health problem

About the Patient's Problem

If you're not sure, it's helpful to tell us whether it's been days, weeks, months or years.
Have you sought advice from a community pharmacist regarding your symptoms? *


There are occasions when patients need to be examined by a clinician which may involve intimate examinations. We are committed to putting patients at ease wherever possible. If you wish for a chaperone to be present during an examination, please specify below.

Does the patient require a chaperone present at the appointment? *

Appointment Type

Please note that after a form is received it will be reviewed by a trained Care Navigator.

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

Anything assessed as priority will be booked into the next available slot (1-2 working days)

Routine health problems (this includes Reviews and follow up appointments) will be booked in within 1-2 weeks.

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

Online message sent through your email


Face to face appointment

Home Visit

Home visits are only for patients who cannot come to the practice, not for transport issues. A clinician will usually phone you to discuss your need for a visit.

Please provide a blood pressure reading, if known.


Please fill in the home readings below if you know any of the following readings.

Will someone be with the patient? *
Do they have a disability?
Please view our full staff list.
The practice can send a text message to your phone with your appointment time. *
Terms & Conditions *