Request an appointment with a Nurse or Healthcare Assistant

Tell us when you want your appointment and we will reply to you with a time. Once we receive this form we will process it within 4 working hours.

If you would like to request an appointment with a Nurse Practitioner or GP, please complete the Get help for any health problem form.

Replies from the surgery may appear in your Junk Inbox.

Request an appointment with a Nurse or Healthcare Assistant (COVID-19)

COVID-19 Screening

Do you have either:

a high temperature - This means you feel hot to touch on your chest or back (you do not need to measure your temperature) *
a new, continuous cough - This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual) *
loss or change to your sense of smell or taste - this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal *
Have you been told by 111 to contact the practice? *
Do you live with someone who has had a high temperature or a new, continuous cough? If their symptoms started more than 14 days ago, click No. *
Please continue to fill out this form
Your symptoms suggest you might have Coronavirus (COVID-19). You should use the 111 online coronavirus service to find out what to do.

Section

The practice can send a text message to your phone with your appointment time. *
Appointment required (tick all that apply):
Cervical screening:
I have received a letter inviting me for my cervical screening: *

If you would like to request an appointment with a Nurse Practitioner, please complete the Get help for any health problem form instead.

Chaperones

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 Time

Have you been told when to have the appointment, for example, "in the next two weeks" or "in one month's time"? *
*