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Request an appointment with a nurse or healthcare assistant

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.

Please do not use this form to request an appointment with a Doctor or Nurse Practitioner – Please use our Get Help from a Doctor or Practitioner form.

Confirmation *

If you are using a UK mobile number, please use the format 07xxxxxxxxx

The practice can send a text message to your phone with your appointment time. *
Appointment required (tick all that apply):

Blood tests must be taken before 1.00pm.

Specify the blood test: *
The best time to have you smear test is halfway through your cycle. That’s 10-14 days after the first day of your period:

If you would like to request an appointment with a Doctor or a Nurse Practitioner, please complete the Get Help from a Doctor or Practitioner form instead.

Have you been told when to have the appointment, for example, “in the next two weeks” or “in one month’s time”? *
Do you require a translator?
Smoking Status:

Smoker

Would you like help to give up smoking?

Ex Smoker

Do you vape?
For applicable devices
*