Request an appointment with a Nurse or Healthcare Assistant

Tell us when you want your appointment and we will reply to you with a time. Once we receive this form we will process it within 1 working day.

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

Please be aware that any replies from the surgery may appear in your junk or spam inbox.

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
*