Request a routine appointment

Do you know the type of appointment that you need?

For example, a follow up, blood test, health review or cervical screening (smear test)

Yes

No

About the appointment

What type of appointment do you need?

Why do you need this appointment?

Tell us about the problem, including if someone asked you to make this request

About the problem

Tell us about the problem

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

Can you think of anything that is worrying you about the problem?

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

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

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Have you been told when to have the appointment? *

Yes

No

When does the appointment need to be? *

When are you available to have the appointment? *

When are you available to have the appointment in the next 3 weeks? *

How would you prefer to be contacted?

Email

Phone

Text message

Video call

Are there any times when you cannot be contacted?

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.

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About the appointment

About the problem