Get help for any health problem

This form is for routine appointment requests only. If you require a same day appointment, please contact the surgery by phone.

This form is open from 07:00 to 12:30 Monday to Friday. Once received you will receive a confirmation email and we aim to respond within 2 working days.

A member of staff will contact you to discuss and book you an appointment. Please contact the surgery if you have submitted a form and it has been longer than two working days without a response.

Please include as much information as possible and this form is for one problem only.

Get help for any health problem
Which surgery do you normally attend? *

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

Online message sent through your email

Telephone

Face to face appointment

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.

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? *

Do you require an interpreter or DA Languages?

The practice can send a text message to your phone with your appointment time. *
Terms & Conditions - Please select both boxes before submitting *
If you think it would be helpful, please upload photo(s) of your condition.
Maximum upload size: 20.97MB