Get help from a Doctor

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. *

Do you have any ideas about what is causing the problem? *

Please state 'N/A' if not applicable.

What are the concerns? *

Please state 'N/A' if not applicable.

How would you like us to help? *

Please state 'N/A' if not applicable.

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

Online message sent through your email

Telephone

Face to face appointment

Online message sent through your email

We might still need to phone you or arrange a face to face appointment. Please tell us if either of these would be a problem for you: *

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: *

Video Consultation

I am willing to accept a video consultation

Video consultations require you to have a smartphone, tablet, laptop or any computer with camera and microphone or headset. You will also require access to the internet, preferably over WiFi. If the practice decides on a video consultation you will be sent an email containing a link for the video consultation, so it's best if you can receive your emails on that same device.

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

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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