Request an urgent on the day appointment

Urgent appointment request

If you require immediate help, please visit NHS 111 Online or call 111. In an emergency, please call 999.

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. *

It may help to describe the problem as if you were speaking to someone

How long has this been a problem? *

It is helpful to tell us if it has been days, weeks, months or years

Do you have an idea about what is causing the problem?

This might be something that happened or you found around the time your symptoms began

What are the concerns?

How would you like us to help?

Is there a member of staff that you would prefer to deal with this problem?

You may need to wait longer for your preference as it depends on their availability

Upload a photograph or document

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

Phone

Face to face appointment

Video call

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.

Are there any times when you cannot be contacted?

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:

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:

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:

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 and conditions *

I confirm that this is not an emergency and understand the surgery cannot help while it is closed. If I need help right now, I will use the NHS 111 service. In an emergency, I will call 999 or go to A&E.

I confirm that I am happy to be seen by a clinician who may not be from my practice.

I confirm that I am responsible for checking my email inbox, including my junk mail, for replies from the surgery.

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Request an urgent on the day appointment

About the patient’s problem